成人腺病毒B组55型重症肺炎11例诊治分析  

Diagnosis and Treatment of 11 Cases of Severe Human Adenovirus Type 55 Pneumonia

作　　者：张志强[1] 翟永志[1] 陈歆[1] 缪媛媛[1] 赵春洪[1] 刘昕[1] 肖红菊[1] 陈钢[2] 刘运喜[3] 刘刚[1] 

机构地区：[1]中国人民解放军总医院发热疾病科,北京市100853 [2]中国人民解放军总医院医院感染管理科,北京市100853 [3]中国人民解放军总医院微生物科,北京市100853

出　　处：《中国全科医学》2013年第35期4200-4203,共4页Chinese General Practice

基　　金：国家科技重大专项(2013ZX1004805-003);解放军总医院临床科研扶持基金(2012FC-TSYS-3033)

摘　　要：目的分析成人腺病毒B组55型重症肺炎患者的临床诊治资料,总结其临床特征及诊治方法。方法回顾性分析2013年4—5月本科收治的经病原学确诊的,符合美国感染疾病学会/美国胸科协会2007年关于成人社区获得性肺炎(CAP)重症肺炎诊断标准的11例成人腺病毒B组55型重症肺炎患者的临床诊治资料。结果 11例患者均为男性,年龄15～41岁,平均(28.5±5.3)岁。9例来自河北省保定地区,其中4例来自同一个县,呈一定的人群、地域聚集分布。临床症状重,11例均有高热、咳嗽、咳痰、胸闷,4例出现了精神障碍,4例伴腹泻。11例患者C反应蛋白(CRP)、白介素6(IL-6)、降钙素原(PCT)水平及中性粒细胞分数均升高;10例清蛋白(ALB)降低;10例乳酸脱氢酶(LDH)升高;9例天冬氨酸氨基转移酶(AST)升高;8例丙氨酸氨基转移酶(ALT)升高;7例肌酸激酶(CK)升高。入院时11例均为Ⅰ型呼吸衰竭,治疗过程中有7例发展为Ⅱ型呼吸衰竭。胸部CT检查示11例均以多肺叶受累的肺实变为主要特征,受累肺叶均多于3叶,其中4例出现空洞,1例出现纵隔气肿、皮下积气。均给予利巴韦林、甲泼尼龙及抗生素等治疗,8例痊愈出院,3例死亡。结论腺病毒B组55型引起的成人重症肺炎临床症状重,除高热、咳嗽等呼吸系统症状外,还伴发腹泻、精神症状等肺外表现。肺部CT以多肺叶受累的肺实变为主要特征,还可出现纵隔、皮下气肿。实验室检查指标中炎性指标升高(CRP、IL-6、PCT及中性粒细胞分数等),ALT、AST、CK、LDH升高,ALB降低。临床工作中发现具有上述特点的患者时需注意进行腺病毒B组55型的相关检查,尽早明确诊断,制定相应的治疗措施,以提高该病的治愈率。Objective To analyze the diagnosis and treatment of severe human adenovirus type 55 pneumonia. Meth- ods The diagnose and treatment data of 11 patients with severe human adenovirus type 55 pneumonia admitted to our department from April 2013 to May 2013 were retrospectively analyzed. Results All of the 11 patients were male adults aged between 15 and 41 years. Nine cases came from Baoding of Hebei province, of which 4 were from the same county. Common clinical symp- toms of 11 cases were fever, cough, expectoration and chest distress. The levels of C - reactive protein （CRP） , interleukin - 6 （IL- 6）, procalcitonin （PCT） and neutrophilic granulocytes of all the 11 cases were higher than the normal values, and the levels of serum glutamic -pyruvic transaminase （GPT） in 8 cases and glutamic -oxaloacetic transaminase （GOT） in 9 cases, creatinine phosphokinase （CK） in 7 cases, lactate dehydrogenase （LDH） levels in 10 cases were higher than the normal val- ues. But the levels of albumin in 10 cases were lower than the normal value. All cases suffered type I respiratory failure when ad- mitted, of which 7 developed into type II respiratory failure. In radiographic examinations, multiple lobar/segment consolidation were the most common HRCT findings. Multiple cavities were found in 4 cases; and subcutaneous and mediastinal emphysema was found in 1 cases. All cases were treated with ribavirin, Methylprednisolone, and antibiotics; 8 cases were recovered and discharged, and 3 cases died. Conclusion The clinical characteristics of severe human adenovirus type 55 pneumonia include severe symptom of respiratory system, multiple lobar/segment consolidation in HRCT and elevated levels of CRP, IL - 6, PCT, GPT, GOT, CK, and LDH. Patients with these clinical characteristics should receive the relative examinations of human adeno- virus type 55 to indentify the severe human adenovirus type 55 pneumonia.

关 键 词：腺病毒感染 人 肺炎 诊断 综合疗法 腺病毒B组55型 

分 类 号：R511.8[医药卫生—内科学]