成人重症腺病毒肺炎的临床特点与诊疗分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

尹辉明 ¹ , 邱飞 ¹ , 谌绍林 ¹ ,  陈平 ²

1. ;
2. ;

Corresponding author：

陈平, Email: pingchen0731@sin.com

Keywords：

腺病毒; 社区获得性肺炎; 临床特点

DOI：

10.7507/1671-6205.201912052

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目的分析成人重症腺病毒肺炎患者的临床资料，总结其临床特点及诊治方法。方法回顾性分析 2019 年 3 月至 9 月收治的 25 例经病原学确诊的重症腺病毒肺炎患者的临床诊治资料。结果 25 例患者中，男 21 例，女 4 例；病原学检查腺病毒 55 型 6 例，7 型 6 例，11 型 2 例，21、4 型各 1 例，未分型 9 例，其中包括混合型 3 例（分别是腺病毒 7 和 55 型，11 和 55 型，7 和 21 型）。CT 表现：一肺叶实变 12 例，两肺叶实变 6 例，多肺叶实变 7 例；8 例合并胸腔积液。7 例（28%）白细胞计数<4×10⁹/L，20 例（80%）中性粒细胞百分比>65%，15 例（60%）血小板计数<150×10⁹/L。25 例（100%）患者 C 反应蛋白>10 mg/L，其中 16 例（64%）患者 CRP>50 mg/L。11 例（44%）降钙素原（PCT）>0.5 μg/L。11 例（44%）PaO₂<60 mm Hg，9 例（36%）PaO₂/FiO₂ <200 mm Hg。9 例（36%）急性生理学和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分>13 分，其中包括腺病毒 55 型 5 例（55.6%），7 型 3 例（33%），未分类 1 例，与 APACHEⅡ评分<13 分组的腺病毒种类比较差异有统计学意义（P<0.05）。15 例（60%）患者采用鼻导管吸氧，4 例（16%）采用无创呼吸机/高流量鼻导管湿化氧疗，6 例（25%）采用有创机械通气。腺病毒种类与以上各因素组间比较无统计学意义（P>0.05）。24 例患者均好转出院，1 例放弃治疗。结论成人重症腺病毒肺炎患者以腺病毒 55 型、7 型多见，实验室检查炎性指标升高（CRP、PCT 及中性粒细胞比例等），白细胞可降低、正常或升高，血小板减少，腺病毒 55 型、7 型比其他类型病情更严重。

Citation： 尹辉明, 邱飞, 谌绍林, 陈平. 成人重症腺病毒肺炎的临床特点与诊疗分析. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(6): 424-426. doi: 10.7507/1671-6205.201912052 Copy

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2.	Jobran S, Kattan R, Shamaa J, et al. Adenovirus respiratory tract infections in infants: a retrospective chart-review study. Lancet, 2018, 391: S43.
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11.	倪鑫. 儿童腺病毒肺炎诊疗规范(2019 年版). 全科医学临床与教育, 2019, 17(7): 579-583.
12.	Park JY, Kim BJ, Lee EJ, et al. Clinical features and courses of adenovirus pneumonia in healthy young adults during an outbreak among Korean military personnel. PLoS One, 2017, 12(1): e0170592.
13.	Yu Z, Zeng Z, Zhang J, et al. Fatal community-acquired pneumonia in children caused by re-emergent human adenovirus 7d associated with higher severity of illness and fatality rate. Sci Rep, 2016, 6: 37216.
14.	Xu L, Liu J, Liu C, et al. Case-control study of the epidemiological and clinical features of human adenovirus 55 and human adenovirus 7 infection in children with acute lower respiratory tract infections in Beijing, China, 2008–2013. BMC Infect Dis, 2018, 18(1): 634.
15.	Yi L, Zou LR, Lu J, et al. A cluster of adenovirus type B55 infection in a neurosurgical inpatient department of a general hospital in Guangdong, China. Influenza Other Respir Viruses, 2017, 11(4): 328-336.
16.	Fu Y, Tang Z, Ye Z, et al. Human adenovirus type 7 infection causes a more severe disease than type 3. BMC Infect Dis, 2019, 19(1): 36.
17.	Xie LY, Zhang B, Zhou JY, et al. Human adenovirus load in respiratory tract secretions are predictors for disease severity in children with human adenovirus pneumonia. Virol J, 2018, 15(1): 123.
18.	Lee YJ, Palomino-Guilen P, Babady NE, et al. Disseminated adenovirus infection in cancer patients presenting with focal pulmonary consolidation. J Clin Microbiol, 2014, 52(1): 350-353.
19.	Wo Y, Lu QB, Huang DD, et al. Epidemical features of HAdV-3 and HAdV-7 in pediatric pneumonia in Chongqing, China. Arch Virol, 2014, 160(3): 633-638.
20.	曹玉书, 钱萍萍, 王广勇, 等. 成人腺病毒重症肺炎早期临床特征. 内科急危重症杂志, 2015, 21(3): 186-188, 194.
21.	Lai CY, Lee CJ, Lu CY, et al. Adenovirus serotype 3 and 7 infection with acute respiratory failure in children in Taiwan, 2010-2011. PLoS One, 2013, 8(1): 1-7.

1. Berciauda S, Raynec F, Kassabb S, et al. Adenovirus infections in Bordeaux University Hospital 2008-2010: clinical and virological features. J Clin Virol, 2012, 54(4): 302-307.
2. Jobran S, Kattan R, Shamaa J, et al. Adenovirus respiratory tract infections in infants: a retrospective chart-review study. Lancet, 2018, 391: S43.
3. Khan S, Keller S, Sritharan N, et al. A rare case of adenovirus pneumonia resulting in severe ARDS in an immunocompetent adult. Chest, 2016, 150(4): 432A.
4. Xie LY, Zhang B, Xiao NG, et al. Epidemiology of human adenovirus infection in children hospitalized with lower respiratory tract infections in Hunan, China. J Med Virol, 2018, 91(5): 392-400.
5. 陈韦, 卓安山, 曹玉书, 等. 成人重症腺病毒肺炎临床研究. 转化医学杂志, 2018, 7(3): 171-174.
6. 葛均波, 徐永健, 王辰, 主编. 内科学(第 9 版), 人民卫生出版社, 北京, 2018.
7. 人腺病毒呼吸道感染预防控制技术指南编写审定专家组. 人腺病毒呼吸道感染预防控制技术指南(2019 年版). 中华预防医学杂志, 2019, 53(11): 1088-1093.
8. Scott MK, Chommanard C, Lu X, et al. Human adenovirus associated with severe respiratory infection, Oregon, USA, 2013-2014. Emerg Infect Dis, 2016, 22(6): 1044-1051.
9. Heo JY, Noh JY, Jeong HW, et al. Molecular epidemiology of human adenovirus-associated febrile respiratory illness in soldiers, South Korea. Emerg Infect Dis, 2018, 24(7): 1221-1227.
10. Yao LH, Wang C, Wei TL, et al. Human adenovirus among hospitalized children with respiratory tract infections in Beijing, China, 2017-2018. Virol J, 2019, 6(1): 78.
11. 倪鑫. 儿童腺病毒肺炎诊疗规范(2019 年版). 全科医学临床与教育, 2019, 17(7): 579-583.
12. Park JY, Kim BJ, Lee EJ, et al. Clinical features and courses of adenovirus pneumonia in healthy young adults during an outbreak among Korean military personnel. PLoS One, 2017, 12(1): e0170592.
13. Yu Z, Zeng Z, Zhang J, et al. Fatal community-acquired pneumonia in children caused by re-emergent human adenovirus 7d associated with higher severity of illness and fatality rate. Sci Rep, 2016, 6: 37216.
14. Xu L, Liu J, Liu C, et al. Case-control study of the epidemiological and clinical features of human adenovirus 55 and human adenovirus 7 infection in children with acute lower respiratory tract infections in Beijing, China, 2008–2013. BMC Infect Dis, 2018, 18(1): 634.
15. Yi L, Zou LR, Lu J, et al. A cluster of adenovirus type B55 infection in a neurosurgical inpatient department of a general hospital in Guangdong, China. Influenza Other Respir Viruses, 2017, 11(4): 328-336.
16. Fu Y, Tang Z, Ye Z, et al. Human adenovirus type 7 infection causes a more severe disease than type 3. BMC Infect Dis, 2019, 19(1): 36.
17. Xie LY, Zhang B, Zhou JY, et al. Human adenovirus load in respiratory tract secretions are predictors for disease severity in children with human adenovirus pneumonia. Virol J, 2018, 15(1): 123.
18. Lee YJ, Palomino-Guilen P, Babady NE, et al. Disseminated adenovirus infection in cancer patients presenting with focal pulmonary consolidation. J Clin Microbiol, 2014, 52(1): 350-353.
19. Wo Y, Lu QB, Huang DD, et al. Epidemical features of HAdV-3 and HAdV-7 in pediatric pneumonia in Chongqing, China. Arch Virol, 2014, 160(3): 633-638.
20. 曹玉书, 钱萍萍, 王广勇, 等. 成人腺病毒重症肺炎早期临床特征. 内科急危重症杂志, 2015, 21(3): 186-188, 194.
21. Lai CY, Lee CJ, Lu CY, et al. Adenovirus serotype 3 and 7 infection with acute respiratory failure in children in Taiwan, 2010-2011. PLoS One, 2013, 8(1): 1-7.

Chinese Journal of Respiratory and Critical Care Medicine

成人重症腺病毒肺炎的临床特点与诊疗分析

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