儿童重症腺病毒肺炎并塑型性支气管炎临床特点分析  

Characteristics of severe adenovirus pneumonia complicated with plastic bronchitis in children

作　　者：胡倩[1] 王承倩 余阅 徐建强[1] 赵辉[1] 郑跃杰[1] 王文建[1] Hu Qian;Wang Chengqian;Yu Yue;Xu Jianqiang;Zhao Hui;Zheng Yuejie;Wang Wenjian(Department of Respiratory Disease,Shenzhen Children′s Hospital,Shenzhen 518038,China)

机构地区：[1]深圳市儿童医院呼吸内科,518038

出　　处：《中国小儿急救医学》2022年第6期451-456,共6页Chinese Pediatric Emergency Medicine

基　　金：深圳市基础研究专项(自然科学基金)基础研究面上项目(JCYJ20190809170007587);深圳市医学重点学科建设经费(SZXK032)。

摘　　要：目的总结儿童腺病毒(HAdVs)相关重症肺炎并塑型性支气管炎(PB)的临床特点及高危因素。方法收集2015年1月1日至2019年10月31日深圳市儿童医院收治的258例HAdVs相关重症肺炎患儿,依据是否合并PB分为PB组(45例)及非PB组(213例),对两组患儿的临床表现、实验室检查、影像学特点和诊治情况进行回顾性分析。结果258例HAdVs相关重症肺炎患儿中,合并PB患儿45例,占17.4%(45/258),PB组男女比例为1.65∶1(28/17),中位年龄为41.0(18.5,65.5)个月。年龄分层方面,PB组6岁以下儿童占80.0%(36/45),6岁以上为20.0%(9/45)。PB组的主要临床症状为高热(95.6%,43/45)、咳嗽(100.0%,45/45)和结膜炎(33.3%,15/45),发热持续时间较非PB组长,差异有统计学意义(Z=-13.519,P<0.001)。与非PB组比较,PB组患儿淋巴细胞计数明显下降[2.24(1.44,3.84)×109/L比1.75(1.21,3.03)×109/L],降钙素原明显升高[0.46(0.19,1.73)ng/mL比1.54(0.37,2.96)ng/mL],且在胸部影像学中,胸腔积液(42.3%比62.2%)及肺不张(22.1%比57.8%)发生率明显增高,差异均有统计学意义(P<0.05)。PB组中,97.8%(44/45)患儿好转后出院,2.2%(1/45)患儿自动出院后死亡。结膜炎(P<0.001,OR=108.514,95%CI 17.476~673.791)、气促(P<0.001,OR=18.788,95%CI 5.172~68.246)和胸腔积液(P=0.007,OR=3.363,95%CI 1.389~8.139)与HAdVs相关重症肺炎患儿是否发生PB存在独立相关性。结论HAdVs相关重症肺炎合并PB在学龄前期儿童多见,高热及咳嗽为主要临床症状,发热持续时间更长,胸腔积液及肺不张发生率明显增高。存在结膜炎、气促及胸腔积液患儿较易发生PB。Objective To summarize the clinical characteristics and investigate risk factors associated with the development of plastic bronchitis(PB)in pediatric patients who have severe pneumonia caused by adenovirus(HAdVs)infections.Methods We retrospectively reviewed the clinical manifestations,laboratory results,radiological examinations,and treatment courses of 258 children who were diagnosed as HAdVs associated severe pneumonia between 1st January,2015 and 31st October,2019 at Shenzhen Children′s Hospital.According to the presence of PB,patients were divided into PB group(n=45)and non-PB group(n=213).Results In PB group,the male to female ratio was 1.65∶1(including 28 boys and 17 girls)and the median age was 41.0(18.5,65.5)months.Patients younger than 6 years of age accounted for 80.0%(36/45)and older patients accounted for 20.0%(9/45).The major clinical symptoms of patients in PB group were high fever(95.6%,43/45),cough(100.0%,45/45)and conjunctivitis(33.3%,15/45).Physical examinations revealed that most patients had tachypnea(80.0%,36/45)and crackles(80.0%,36/45).Compared to patients in non-PB group,the duration of fever in PB group was significant longer(Z=-13.519,P<0.001).Compared to non-PB group,there was a significant decrease of the lymphocyte count[2.24(1.44,3.84)×109/L vs.1.75(1.21,3.03)×109/L]and a significantly increase of the procalcitonin level[0.46(0.19,1.73)ng/mL vs.1.54(0.37,2.96)ng/mL]in PB group(P<0.05).Chest radiological examinations revealed that patients in PB group had higher rates to develop pleural effusion(62.2%vs.42.3%)and atelectasis(57.8%vs.22.1%)of the lungs compared to non-PB group(P<0.05).The majority of patients improved after resolution of symptoms(97.8%,44/45)in PB group.Only one patient(2.2%,1/45)died due to discontinuation of treatment.Conjunctivitis(P<0.001,OR=108.514,95%CI 17.476-673.791),tachypnea(P<0.001,OR=18.788,95%CI 5.172-68.246),pleural effusion(P=0.007,OR=3.363,95%CI 1.389-8.139)were independent risk factors associated with the development of PB in children with HAdV

关 键 词：腺病毒 肺炎 塑型性支气管炎 儿童 临床特征 

分 类 号：R725.6[医药卫生—儿科]