成人重癥腺病毒肺炎的臨床特點與診療分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

尹輝明 ¹ , 邱飛 ¹ , 諶紹林 ¹ ,  陳平 ²

1. ;
2. ;

Corresponding?author：

陳平, Email: pingchen0731@sin.com

Keywords：

腺病毒; 社區獲得性肺炎; 臨床特點

DOI：

10.7507/1671-6205.201912052

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目的分析成人重癥腺病毒肺炎患者的臨床資料，總結其臨床特點及診治方法。方法回顧性分析 2019 年 3 月至 9 月收治的 25 例經病原學確診的重癥腺病毒肺炎患者的臨床診治資料。結果 25 例患者中，男 21 例，女 4 例；病原學檢查腺病毒 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（分別是腺病毒 7 和 55 型，11 和 55 型，7 和 21 型）。CT 表現：一肺葉實變 12 例，兩肺葉實變 6 例，多肺葉實變 7 例；8 例合并胸腔積液。7 例（28%）白細胞計數<4×10⁹/L，20 例（80%）中性粒細胞百分比>65%，15 例（60%）血小板計數<150×10⁹/L。25 例（100%）患者 C 反應蛋白>10 mg/L，其中 16 例（64%）患者 CRP>50 mg/L。11 例（44%）降鈣素原（PCT）>0.5 μg/L。11 例（44%）PaO₂<60 mm Hg，9 例（36%）PaO₂/FiO₂ <200 mm Hg。9 例（36%）急性生理學和慢性健康狀況評分系統Ⅱ（APACHEⅡ）評分>13 分，其中包括腺病毒 55 型 5 例（55.6%），7 型 3 例（33%），未分類 1 例，與 APACHEⅡ評分<13 分組的腺病毒種類比較差異有統計學意義（P<0.05）。15 例（60%）患者采用鼻導管吸氧，4 例（16%）采用無創呼吸機/高流量鼻導管濕化氧療，6 例（25%）采用有創機械通氣。腺病毒種類與以上各因素組間比較無統計學意義（P>0.05）。24 例患者均好轉出院，1 例放棄治療。結論成人重癥腺病毒肺炎患者以腺病毒 55 型、7 型多見，實驗室檢查炎性指標升高（CRP、PCT 及中性粒細胞比例等），白細胞可降低、正常或升高，血小板減少，腺病毒 55 型、7 型比其他類型病情更嚴重。

Citation： 尹輝明, 邱飛, 諶紹林, 陳平. 成人重癥腺病毒肺炎的臨床特點與診療分析. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(6): 424-426. doi: 10.7507/1671-6205.201912052 Copy

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.	陳韋, 卓安山, 曹玉書, 等. 成人重癥腺病毒肺炎臨床研究. 轉化醫學雜志, 2018, 7(3): 171-174.
6.	葛均波, 徐永健, 王辰, 主編. 內科學(第 9 版), 人民衛生出版社, 北京, 2018.
7.	人腺病毒呼吸道感染預防控制技術指南編寫審定專家組. 人腺病毒呼吸道感染預防控制技術指南(2019 年版). 中華預防醫學雜志, 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. 兒童腺病毒肺炎診療規范(2019 年版). 全科醫學臨床與教育, 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.	曹玉書, 錢萍萍, 王廣勇, 等. 成人腺病毒重癥肺炎早期臨床特征. 內科急危重癥雜志, 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. 陳韋, 卓安山, 曹玉書, 等. 成人重癥腺病毒肺炎臨床研究. 轉化醫學雜志, 2018, 7(3): 171-174.
6. 葛均波, 徐永健, 王辰, 主編. 內科學(第 9 版), 人民衛生出版社, 北京, 2018.
7. 人腺病毒呼吸道感染預防控制技術指南編寫審定專家組. 人腺病毒呼吸道感染預防控制技術指南(2019 年版). 中華預防醫學雜志, 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. 兒童腺病毒肺炎診療規范(2019 年版). 全科醫學臨床與教育, 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. 曹玉書, 錢萍萍, 王廣勇, 等. 成人腺病毒重癥肺炎早期臨床特征. 內科急危重癥雜志, 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

成人重癥腺病毒肺炎的臨床特點與診療分析

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