腺病毒7型致呼吸道感染暴发流行的临床特点与治疗探讨  

Clinical characteristics and strategies of treatment for outbreak of respiratory tract infection caused by adenovirus type 7

作　　者：李红梅[1] 郭青云[1] 蒲秀红[1] 张葆[1] 宋祖军[1] 

机构地区：[1]解放军309医院,北京100091

出　　处：《内科急危重症杂志》2015年第3期183-185,共3页Journal of Critical Care In Internal Medicine

摘　　要：目的:分析一起腺病毒7型呼吸道感染暴发流行的临床特点和治疗经验。方法:首发病例及其陪护咽拭子行RT-PCR检测及序列测定鉴别病原体类型及变异情况。密切接触者53例取鼻咽拭子标本行甲型流感病毒和腺病毒核酸抗原检测,腺病毒核酸阳性者取隔离初期及解除隔离前双份血清标本,行腺病毒Ig M抗体测定,隔离初期抽血检测淋巴细胞亚群。并对临床资料进行回顾性分析。结果:53例密切接触者中17例腺病毒阳性,其中隐性感染者9例,急性上呼吸道感染4例,腺病毒性肺炎4例,其中重症肺炎3例,腺病毒阳性患者采用静脉滴注利巴韦林及中西医结合抗病毒治疗,重症腺病毒肺炎给予甲泼尼龙抗炎治疗及提高免疫力等综合治疗,除首发病例死亡外,均治愈。结论:早诊断、早隔离、早治疗是控制腺病毒呼吸道感染暴发流行和改善预后的关键。Objective： To analyze the clinical features of an outbreak of acute respiratory tract infection caused by adenovirus type 7 and to explore the strategies of clinical treatment. Methods： Pharyngeal swabs were detected by RT-PCR in the initial case and the escorts. Sequence determination was used to identify the type of the pathogen and its variations. Nasopharyngeal specimen of fifty-three close contacts were collected and detected for influenza A virus and adenovirus DNA with PCR. Adenovirus DNA positive patients were isolated. IgM antibody of adenovirus was determined at the beginning and at the end of isolation. Lymphocyte subpopulations in blood was observed at the beginning of isolation. The clinical data were analyzed retrospectively. Results： Seventeen patients were adenovirus type 7 DNA positive among the fifty-three close contacts. Nine cases were with latent infection,4 with acute upper respiratory tract infection and 4 with adenovirus pneumonia,3 of them were severe pneumonia. Patients with adenovirus positive received intravenous infusion of Ribavirin. In severe infection glucocorticoid combined with treatment for promotion of immunity can effectively alleviate the pulmonary and systemic inflammatory reaction. All patients were cured except the initial case. Conclusions： Early diagnosis,isolation and treatment are crucial to control the outbreak of respiratory tract infection caused by adenovirus type 7 and to improve the prognosis.

关 键 词：腺病毒7型 暴发流行 临床特点 治疗 

分 类 号：R56[医药卫生—呼吸系统]