| 摘要: |
| [摘要]目的：分析重症腺病毒肺炎患儿临床特征、炎症指标及免疫指标。方法：回顾性分析2018年6月至2019年12月湖南省儿童医院确诊的91例腺病毒肺炎患儿临床特征及免疫相关指标，根据患儿疾病严重程度分为重症腺病毒肺炎组（重症组）49例及非重症腺病毒肺炎组（非重症组）42例，重症组患儿根据是否发生闭塞性细支气管炎（BO）分为BO组和非BO组。所有患儿均给予止咳化痰、平喘及补液等对症支持治疗，合并感染或有感染高危因素者给予抗感染治疗，重症组给予丙种球蛋白、呼吸机辅助通气、甲泼尼龙抗炎及血液净化清除炎症介质等治疗。结果：腺病毒肺炎大多发生于<5岁患儿，占86.8%（79/91），病死率5.5%（5/91），其中重症为46.2%（42/91）。患儿年龄越小，病情越重，病死率越高，需机械通气及发生BO例数越多，住院时间及住ICU时间越长（P<0.05）。重症组中，71.4%（30/42）给予抗感染，54.8%（23/42）给予丙种球蛋白免疫治疗，47.6%（20/42）需机械通气及肺泡灌洗，38.1%（16/42）给予甲泼尼龙抑制机体炎症反应，19.0%（8/42）行血液净化清除体内炎症介质等，其中病死率为11.9%（5/42），23.8%（10/42）发生BO。重症组患儿白细胞计数（WBC）、中性粒细胞计数（N）、C反应蛋白（CRP）、血沉（ESR）、降钙素原（PCT）、免疫球蛋白E（IgE）及白细胞介素6（IL-6）水平较非重症组高，淋巴细胞亚群及免疫全套指标（IgM除外）较非重症组低（P<0.05）。BO组WBC、N、CRP、IgE、IL-6水平较非BO组高，B淋巴细胞、CD3+、CD4+、Th/Ts、C3、IgA水平较非BO组低（P<0.05）。BO组支气管肺泡灌洗液中性粒细胞水平较非BO组高（P<0.05）。结论：重症腺病毒肺炎患儿体内存在较强的炎症反应和免疫功能紊乱，病死率较高且易导致BO，临床应早期监测各项炎症及免疫指标，以尽早采取免疫支持及抑制或清除炎症因子等干预措施和综合治疗，并重视BO防治，改善预后。 |
| 关键词: 腺病毒 重症肺炎 闭塞性支气管炎 儿童 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.201.10.002 |
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| 基金项目:2019 年国家医疗服务与保障能力提升(医疗卫生机构能力建设)项目,国卫办医函也2019页542 号;儿童急救医学湖南省重点实验室,编号2018TP1028。 |
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| Clinical Characteristics and Immune Indicators in Children with Severe Adenovirus Pneumonia |
| Fan Jianghua, Luo Haiyan, Zhang Xinping, Zhao Xiaoping, Duan Wei, Xie Bo, Xiao Zhenghui |
| (Hunan Children’s Hospital, Hunan Changsha 410007, China) |
| Abstract: |
| [Abstract] Objective: To analyze the clinical characteristics, inflammatory and immune indicators in children with severe adenovirus pneumonia. Methods: Clinical characteristics and immune indicators of 91 children with adenovirus pneumonia diagnosed in Hunan Children’s Hospital from Jun. 2018 to Dec. 2019 were retrospectively analyzed. According to the severity of disease, all children were divided into 49 cases in the severe adenovirus pneumonia group (severe group) and 42 cases in the non-severe adenovirus pneumonia group (non-severe group). According to the occurrence of bronchiolitis obliterans (BO), children in the severe group were divided into the BO group and the non-BO group. All children were given symptomatic supportive treatment such as cough and sputum relief, wheezing relief and rehydration, and anti-infection treatment was given to those children with co-infection or high risk factors. Patients in the severe group were treated with gamma globulin, ventilator-assisted ventilation, methylprednisolone anti-inflammatory and blood purification to remove inflammatory mediators. Results: Adenovirus pneumonia mostly occurred in children <5 years old, accounting for 86.8% (79/91), and the mortality rate was 5.5% (5/91), of which 46.2% (42/91) were severe. The younger the children, the more severe the condition, the higher the mortality rate, the greater the number of cases requiring mechanical ventilation and BO, and the longer the length of hospitalization and ICU stay (P<0.05). In the severe group, 71.4% (30/42) were given anti-infection treatment, 54.8% (23/42) were given gamma globulin immunotherapy, 47.6% (20/42) required mechanical ventilation and alveolar lavage, 38.1% (16/42) were given methylprednisolone to inhibit the inflammatory response of the body, and 19.0% (8/42) underwent blood purification to remove inflammatory mediators. The mortality rate was 11.9% (5/42), and BO occurred in 23.8% (10/42). The levels of white blood cell count (WBC), neutrophil count (N), C-reactive protein (CRP), erythrocyto sedimentation rate (ESR), proealcitonin (PCT), immunoglobulin E (IgE) and interleukin 6 (IL-6) in the severe group were higher than those in the non-severe group, and the lymphocyte subsets and immune indicators (except for IgM) were lower than those in the non-severe group (P<0.05). The levels of WBC, N, CRP, IgE and IL-6 in the BO group were higher than those in the non-BO group, while the levels of B lymphocytes, CD3+, CD4+, Th/Ts, C3 and IgA were lower than those in the non-BO group (P<0.05). The level of neutrophil in bronchoalveolar lavage fluid in the BO group was higher than that in the non-BO group (P<0.05). Conclusion: Children with severe adenovirus pneumonia have the strong inflammatory and immune dysfunction, with higher mortality rate, and it is easy to prone to BO. Clinical monitoring of inflammatory and immune parameters should be carried out at an early stage, so that interventions and comprehensive treatment such as immune support therapy and inhibition or removal of inflammatory factors can be carried out as early as possible, and emphasis should be placed on BO prevention and treatment to improve the prognosis. |
| Key words: adenovirus severe pneumonia bronchiolitis obliterans children |
