儿童腺病毒肺炎并发噬血细胞综合征7例临床分析

Adenovirus pneumonia with hemophagocytic lymphohistiocytosis in children: a clinical analysis of 7 children

摘要:

目的 探讨儿童腺病毒肺炎并发噬血细胞综合征（HLH）的临床特征。方法 回顾性分析2019年3~9月7例腺病毒肺炎并发HLH患儿的临床资料。结果 患儿年龄11个月至5岁，其中2岁以下5例，男性5例，均无基础疾病。患儿均以持续高热伴咳嗽住院，热峰在39~41℃之间。随着疾病进展，出现肝大7例，脾大6例。血常规两系或三系减少，伴血清铁蛋白（SF）、C反应蛋白（CRP）、降钙素原（PCT）、乳酸脱氢酶（LDH）升高。吞噬血细胞现象6例。肺部影像学提示肺炎改变。7例均经病原学宏基因检测鉴定为人腺病毒7型感染，同时HLH基因检测无异常，确诊为继发性HLH。7例均采用人免疫球蛋白治疗，地塞米松+依托泊苷化疗4例，单用地塞米松3例，血浆置换4例。死亡2例，好转出院5例。与5例存活患儿相比，2例死亡病例血常规中三系降低更明显，CRP、PCT、SF、LDH升高更明显。结论 腺病毒肺炎并发HLH的主要临床特征为持续高热，外周血出现进行性两系或三系降低及肝脾肿大等其他器官系统受累。CRP、PCT、SF、LDH显著升高可能提示预后不良。

Abstract:

Objective To study the clinical features of children with adenovirus pneumonia and hemophagocytic lymphohistiocytosis (HLH). Methods A retrospective analysis was performed on the mediacal data of 7 children with adenovirus pneumonia and HLH from March to September, 2019. Results The age of these children ranged from 11 months to 5 years, and among these children, 5 were aged < 2 years and 5 were boys. None of these children had underlying diseases. All children were hospitalized due to persistent high fever and cough, and the peak temperature of fever was 39℃ to 41℃. With disease progression, 7 children developed hepatomegaly and 6 developed splenomegaly. Routine blood test results showed reductions in two or three lineages of blood cells, with increases in serum ferritin (SF), C-reactive protein (CRP), procalcitonin (PCT), and lactate dehydrogenase (LDH). Phagocytosis of blood cells was observed in 6 children. Radiological examination of lungs showed pneumonia changes. All 7 children were diagnosed with human adenovirus type 7 infection based on pathogenic metagenome detection. No abnormality was found by HLH gene detection and the children were diagnosed with secondary HLH. All children received intravenous immunoglobulin. Among these children, 4 received dexamethasone and etoposide chemotherapy, 3 received dexamethasone alone, and 4 received plasma exchange. Of the 7 children, 2 died and 5 were recovered. Compared with those who survived, the children who died had significantly greater reductions in the three lineages of blood cells and significantly greater increases in serum levels of CRP, PCT, SF, and LDH. Conclusions The children with adenovirus pneumonia and HLH have main clinical features of persistent high fever, progressive reductions in two or three lineages of peripheral blood cells, and involvement of other organ systems, including hepatosplenomegaly. Significant increases in serum levels of CRP, PCT, SF, and LDH may suggest a poor prognosis.