曹玉书,钱萍萍.成人腺病毒肺炎重症化早期临床特征[J].内科急危重症杂志,2015,21(3):
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| DOI： |
| 中文关键词: 腺病毒肺炎 重症化 临床特征 成人 |
| 英文关键词:adenoviral pneumonia onset of deterioration clinical features adult |
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| 中文摘要: |
| 目的：观察6例腺病毒肺炎（severe adenovirus pneumonia，SAdVP）病人重症化早期的临床特点，探讨SAdVP的早期识别。方法：一起聚集性发病的呼吸道7型腺病毒感染病人，重症腺病毒肺炎6例和轻症39例，回顾性分析病情进展至重症前的病史、临床症状与体征、实验室、影像学异常，以及早期治疗反应并与轻症组比较。结果：6例SAdVP病人均为疫情暴发后首批入院，入院时肺炎严重度评分（59.2±32.3）；肺炎发病前有2～4ｗ的间歇或持续的咳嗽病史5例；入院前表现高热（40.17±0.85）℃（与轻症组比较，p<0.001）和剧烈咳嗽（4.03±0.75），高热时间2～6ｄ，平均（4.83±2.14）d；意识障碍2例、生命体征异常和低氧血症2例；胸部CT叶、段性实变伴磨玻璃影（ground glass opacity，GGO）6例，CT进展表现为大片GGO为主的病灶迅速扩大、密度增高和多种形态的新发病灶；入院白细胞、中性粒细胞增高3例，血小板减少4例（血小板计数与轻症组比较，p<0.001）；血液腺病毒核酸检测阳性5例；甲泼尼龙等早期治疗后，低体温1例，持续发热4例、二次发热2例，剧烈咳嗽不缓解6例。达到重症肺炎的热程6～8 d，平均（6.17±0.37）d。结论：持续高热并剧烈咳嗽大于3天，胸部CT出现大片GGO和迅速进展为大叶性病灶，血小板减少，血液腺病毒核酸检测阳性，以及早期治疗反应差等，是成人腺病毒肺炎重症化早期的主要特点。 |
| 英文摘要: |
| [Abstract] Objective To observe the early clinical features of 6 patients suffering from severe adenovirus pneumonia (SAdVP) in order to look for its early identification. Methods According to the diagnostic guidelines of adenovirus pneumonia,6 severe cases and 39 mild cases during an epidemic of respiratory infection were proven to be type 7 adenovirus infection when hospital admission. Clinical symptoms and signs, laboratory testing, imaging examination and hormone application before deterioration of the illness were retrospectively analyzed. Results 6 cases were in the first batch of admission to our hospital after the epidemic with pneumonia severity index(PSI)(59.2±32.3). The duration from onset to severe illness average (6.17±0.37 d) (range,6～8 d).while the period of high fever（>39℃）was (4.83±2.14 d) (range, 2～6 d) with the temperature reaching (40.17±0.85) ℃ and coughing severity score (4.03±0.75, 5 scorings). 5 cases had an intermittent or persistent cough of unknown cause for 2～4w prior to the onset of the pneumonia. Disturbances of consciousness alternated in 2 patients, vital signs, blood oxygen saturation abnormalities happened in 2 cases. Early chest CT pattern was patchy consolidation, ground glass opacity(GGO), interstitial changes and small nodules; Progression of chest CT manifested as enlargement and newly emerging lesions which characterized by a large range of GGO damage; In 6 severe cases CT showed lobar or segmental consolidation with or without GGO; After methylprednisolone therapy persistent fever in 4, secondary fever in 2, hypothermia in one still occurred; Unrelieved severe coughing exited in each of the 6 cases. Blood adenovirus nucleic acid testing was positive in 5 cases in early period. Leukocytes and neutrophils heighten in 3, Platelets declined in 4 cases, CRP increased in 6, procalcitonin elevated in 2,LDH and creatine kinase raised up in 3, while fibrinogen, cholinesterase and other indicators had no significant abnormalities. Conclusions Persistent hyperpyrexia and severe coughing more than 3 days, lobar lesions and large areas of GGO in chest CT, adenovirus nucleic acid positive in blood samples, thrombocytopenia and poor responses to hormone therapy are main performance before deterioration of patients suffering from adenovirus pneumonia. |
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