腺病毒肺炎12例临床特点和鉴别诊断分析

目的提高对腺病毒肺炎的再认识。方法选取2001年3月至2005年4月确诊的12例腺病毒肺炎患儿为对象,对其临床特点和辅助检查进行分析,并且与10例肺炎链球菌肺炎、10例呼吸道合胞病毒肺炎患儿的临床特点进行比较。结果12例腺病毒肺炎患儿均持续高热、有细湿罗音,10例(83.3%)患儿有持续性的喘鸣音、并出现合并症,其中合并心力衰竭10例(83.3%),呼吸衰竭6例(50.0%),中毒性肝炎6例(50.0%),脑病2例(16.7%),心肌炎1例(8.3%)。死亡2例。影像学特点:为假大叶5例,有大片影5例,小片融合灶1例,薄片影1例,有肺气肿9例,有肺门增大7例。10例(83.3%)患儿的胸片示病灶逐渐增多成为多叶的病灶。与其他两种肺炎比较,腺病毒肺炎合并症发生率高,需用IVIG和全身激素的比率明显较对照组为高。结论腺病毒肺炎的合并症发生率高,病死率高,治疗难度大。

Clinical features and differential diagnosis of adenovirus pneumonia

Objectives To recognize the feature of adenovirus pneumonia in children.Methods The data from 12 cases with adenovirus pneumonia admitted to hospital from March 2001 to April 2005 were reviewed.Clinical features and reports of chest roentgenograms were analyzed and the comparisons were made among adenovirus pneumonia,streptococcal pneumonia(10 cases),and respiratory syncytial virus pneumonia(10 cases).Results All of the 12 cases had conti-nuous high fever and the rales in the chest,and 10 patients(83.3%)had persisting wheezing.10 patients had complications,including heart failure(10 cases),respiratory failure(6 cases),toxic hepatitis(6 cases),encephalopathy(2 cases),and myocarditis(1 case),and two died.The chest roentgenogram features of adenovirus pneumonia showed lobar consolidation(5 cases),big patchy(5 case),shadows of multi-lobular consolidation(1 case),emphysema(9 cases),and greater density of the perihilar shadows(7 cases).In 10 cases,their patchy became extended and bigger consolidated gradually and involved more than one lobar.In comparison with other two types,the rate of the complication was higher in adenovirus pneumonia,more cases need treatment with corticosteroids and IVIG.Conclusions Adenovirus pneumonia is a severe pneumonia with more complication and mortality,and it is difficult to be treated.