儿童重症腺病毒肺炎并噬血细胞综合征30例临床特征分析

Clinical features of children with severe adenovirus pneumonia and hemophagocytic syndrome: an analysis of 30 cases

摘要:

目的 总结儿童重症腺病毒肺炎（SAP）并噬血细胞综合征（HPS）的临床特征。方法 回顾性分析2014年1月至2019年6月收治的30例SAP并HPS患儿的临床资料，根据预后情况分为临床好转组（n=18），和预后不良组（n=12），总结其临床特点。结果 30例SAP并HPS患儿中，男女比例2：1，中位起病年龄为1岁3个月（范围：3个月至5岁），平均热程19±7 d，28例（93%）在1~6月份发病。16例（53%）患儿通过血清感染病原高通量基因检测提示为人腺病毒7型（HAdV-7）感染，另14例（47%）通过咽拭子免疫荧光法提示HAdV抗原阳性，具体分型未知。29例（97%）出现呼吸系统并发症，24例（80%）出现心血管系统并发症，16例（53%）出现消化系统并发症，9例（30%）出现中毒性脑病。18例（60%）临床好转或治愈，12例（40%）临床未愈，其中3例死亡（10%）。预后不良组发病至确诊HPS病程长于临床好转组（P < 0.05）。预后不良组纤维蛋白原、肿瘤坏死因子-α高于临床好转组（P < 0.05）。预后不良组干扰素-γ低于临床好转组（P < 0.05）。27例存活患儿平均随访6±2个月，11例（41%）临床痊愈，1例（4%）HPS复发，15例（56%）出现感染后闭塞性细支气管炎后遗症。结论 SAP可合并HPS，后遗症以感染后闭塞性细支气管炎最常见。

Abstract:

Objective To study the clinical features of children with severe adenovirus pneumonia (SAP) and hemophagocytic syndrome (HPS). Methods A retrospective analysis was performed from the chart review data of 30 children with SAP and HPS who were admitted from January 2014 to June 2019. According to the prognosis, the children were divided into a good prognosis group (n=18) and a poor prognosis group (n=12). Results Among the 30 children with SAP and HPS, the ratio of male to female was 2:1. The median age of onset was 1 year and 3 months (range 3 months to 5 years), and the mean course of fever was 19±7 d. Of the 30 children, 28 (93%) experienced disease onset in January to June. High-throughput gene detection of serum pathogens showed that 16 (53%) children were positive for human adenovirus type 7 (HAdV-7), and the other 14 (47%) children were positive for HAdV antigen based on immunofluorescence assay for throat swab, with unknown type. Of all 30 children, 29 (97%) had respiratory complications, 24 (80%) had cardiovascular complications, 16 (53%) had gastrointestinal complications, and 9 (30%) had toxic encephalopathy. Eighteen children (60%) improved or recovered and 12 (40%) did not recover (3 died). Compared with the good prognosis group, the poor prognosis group had a significantly longer course from onset to diagnosis of HPS (P < 0.05), significantly higher levels of fibrinogen and tumor necrosis factor-α (P < 0.05), and a significantly lower level of interferon-γ (P < 0.05). The mean follow-up time was 6±2 months; 11 (41%) children recovered, 1 (4%) experienced recurrence of HPS, and 15 (56%) had the sequela of post-infectious bronchiolitis obliterans (PIBO). Conclusions HPS may be observed in children with SAP, and PIBO is the most common sequela of SAP.