重症腺病毒肺炎临床特点及并发闭塞性细支气管炎危险因素分析

目的　总结重症腺病毒肺炎（severe adenovirus pneumonia，SAP）的临床特点，分析其并发闭塞性细支气管炎（bronchiolitis obliterans，BO）的危险因素。方法　对南京医科大学附属儿童医院呼吸科2017年1月至2019年12月住院的125例SAP患儿进行回顾分析，总结其临床特点。根据是否发展为BO将患儿分为BO组和非BO组，并对临床资料进行分析。结果　发病年龄≤24月龄80例（64%）；热峰≥39℃者115例（94.3％），热程≥10 d者89例（72.9％）；气喘82例（65.6%）；单纯腺病毒感染35例（28%），72%的患儿合并其他病原体感染［肺炎支原体（MP）40.8%，细菌35.2%］；并发呼吸衰竭32例（25.6%），肺外并发症以循环系统（36%）和消化系统并发症（22.4%）多见。实访122例SAP患儿，53例（43.4%）最终发展为BO。多因素Logistic回归分析显示呼吸衰竭和合并MP感染是SAP后BO的独立危险因素（P＜0. 05）。结论　SAP主要发生于2岁以下的婴幼儿，多为高热且持续时间长，多数患儿存在喘息，混合感染率高；最常见的并发症是呼吸衰竭、 心功能不全、 肝功能损害和中毒性脑病。呼吸衰竭和合并MP感染是SAP后BO的独立危险因素。

Clinical characteristics of severe adenovirus pneumonia and risk factors of concurrent bronchiolitis obliterans

Objective　To summarize the clinical characteristics of severe adenovirus pneumonia（SAP） and analyze the risk factors of concurrent bronchiolitis obliterans（BO）. Methods　The clinical data of 125 children with SAP admitted to the Department of Respiratory Medicine，Children’s Hospital of Nanjing Medical University，from January 2017 to December 2019 were retrospectively analyzed and the clinical features were summarized. The children were divided into BO group and non-BO group according to whether they developed BO，and the clinical data were analyzed. Results　A total of 80 cases（64%） had age of onset ≤ 24 months，115 cases（94.3%） had fever peak≥ 39℃，89 cases（72.9%） had fever duration ≥ 10 d，82 cases（65.6%） had asthma. Adenovirus infection alone was in 35 cases（28%），and 72% were infected with other pathogens［Mycoplasma pneumonia（MP） 40.8%，bacteria 35.2%］；32 cases（25.6%） had respiratory failure，and extrapulmonary complications were common in circulatory system（36%） and digestive system（22.4%）. Of the 125 children with SAP，122 were actually followed up，and 53（43.4%） eventually developed into BO. Multivariate Logistic regression analysis showed that respiratory failure and combined MP infection were independent risk factors for BO after SAP（P＜0. 05）. Conclusion　SAP mainly occurs in infants under 2 years of age，with high fever and long duration. Most children have wheezing and high rate of mixed infection. The most common complications are respiratory failure，cardiac insufficiency，liver function damage and toxic encephalopathy. Respiratory failure and combined MP infection are independent risk factors for BO after severe adenovirus pneumonia.