儿童重症7型腺病毒肺炎45例临床分析

Clinical features of severe type 7 adenovirus pneumonia: an analysis of 45 cases

摘要:

目的 总结儿童重症7型腺病毒肺炎的临床特点，以期为临床的诊断治疗提供经验。方法 回顾性分析2019年2~6月确诊为重症7型腺病毒肺炎患儿的临床资料。结果 45例患儿中男女比为3：2，中位年龄为14个月，均有反复高热、咳嗽、肺部湿啰音，平均热程为14±4 d，发热至呼吸困难的中位时间为8 d，发热至需要呼吸机机械通气的平均时间为11.6±2.5 d。WBC无明显升高，以中性粒细胞为主；血红蛋白、白蛋白轻度下降；血小板、纤维蛋白原正常；天冬氨酸氨基转移酶、乳酸脱氢酶、降钙素原及C反应蛋白均升高。混合病原体检出率为84%。胸部影像学改变以双肺渗出为主（64%）。支气管镜下表现为支气管内膜炎、气管软化、塑形支气管炎。呼吸系统并发症发生率为100%，肺外并发症主要累及循环系统（47%）、消化系统（36%）和神经系统（31%）。16例患儿的给药方案为静脉注射丙种球蛋白（IVIG）每日400 mg/kg，连用5 d，平均热程为16±5 d；29例患儿的给药方案为IVIG每日1 g/kg，连用2 d，平均热程为13±4 d；两种给药方案治疗患儿的平均热程比较差异有统计学意义（P=0.046）。总病死率为11%。结论 儿童重症7型腺病毒肺炎病情重，并发症发生率高，病死率高，需早诊断，早治疗。

Abstract:

Objective To study the clinical features of severe type 7 adenovirus pneumonia in children. Methods A retrospective analysis was performed for the clinical data of children who were diagnosed with severe type 7 adenovirus pneumonia from February to June, 2019. Results Among the 45 children, the male/female ratio was 3:2 and the median age was 14 months. All children had repeated fever, cough, and pulmonary moist rales, and the mean duration of fever was 14±4 days. The median time from fever to dyspnea was 8 days, and the time from fever to mechanical ventilation was 11.6±2.5 d. There was no significant increase in white blood cell count, with neutrophils as the main type. There were slight reductions in hemoglobin and albumin, while platelet and fibrinogen remained normal. There were increases in aspartate aminotransferase, lactate dehydrogenase, procalcitonin, and C-reaction protein. The detection rate of mixed pathogens was 84%. Effusion in both lungs was the major change on chest imaging (64%). Bronchoscopic manifestations were endobronchitis, tracheomalacia, and plastic bronchitis. The incidence rate of respiratory complications was 100%, and extrapulmonary complications mainly involved the circulatory system (47%), digestive system (36%), and nervous system (31%). Among the 45 children, 16 were administered with 400 mg/kg intravenous immunoglobulin (IVIG) daily for 5 days, with a mean duration of fever of 16±5 days, and 29 were administered with 1 g/kg IVIG daily for 2 days, with a mean duration of fever of 13±4 days; there was a significant difference in the mean duration of fever between the two groups (P=0.046). The overall mortality rate was 11%. Conclusions Severe type 7 adenovirus pneumonia in children has severe conditions, with a high incidence rate of complications and a high mortality rate, so it should be diagnosed and treated as early as possible.