成人重症腺病毒肺炎临床特征及预后

doi:10.3969/j.issn.2095-9400.2020.03.013

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摘要目的：探讨成人重症腺病毒肺炎的临床特征及预后情况。方法：回顾性分析2017年3月至2019年5月温州医科大学附属第一医院收治的成人重症腺病毒肺炎病例资料。结果：7例患者，均为男性，年龄23～50（35±10）岁。主要症状为发热（7/7）、呼吸困难（7/7）、咳嗽（7/7）、胸痛（1/7）。APACHE II评分5～20（10.1±5.0）分。实验室检查以白细胞正常、肌酶升高为主。腺病毒确诊方法：病原微生物高通量测序（mNGS）6例，抗原测定阳性1例。腺病毒血清型7型3例，55型2例，4型1例，不明1例。3例予气管插管呼吸机支持，1例气管切开呼吸机支持，无创呼吸机支持通气3例，机械通气时间5～46 d。治疗包括静脉丙种球蛋白应用7例，更昔洛韦和利巴韦林抗病毒治疗3例。6例好转出院，1例死亡。结论：成人重症腺病毒肺炎易发生于中青年男性，mNGS可快速确定病原菌，处理以对症支持治疗为主。

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	张胜男
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	叶君如
	张冬青
	周玲萍
	李玉苹

关键词 ：腺病毒, 重症, 社区获得性肺炎, 成人

Abstract：Objective: To investigate the clinical features and prognosis of adult severe adenovirus pneumonia. Methods: Adult cases with severe adenovirus pneumonia who were admitted in the First Affiliated Hospital of Wenzhou Medical University from March 2017 to May 2019 were retrospectively analyzed. Results: Seven male patients aged 23-50 years, with an average age of (35±10) years, were enrolled. The main clinical symptoms were fever (7/7 cases), dyspnea (7/7 cases), cough (7/7 cases) and chest pain (1/7 cases). APACHE II score was 5-20 points, with an average points (10.1± 5.0). Laboratory test included normal BRT value and increased creatine kinase. Adenovirus was identified by metagenomics next-generation sequencing (mNGS) in 6 cases, and 1 case was confirmed through positive adenovirus antigen from BALF. There were 3 cases of serotype 7, 2 cases of type 55, 1 case of type 4, and 1 case unknown. Three patients were supported by tracheal intubation ventilator, 1 patient underwent tracheotomy and ventilator support and 3 patients were supported by noninvasive ventilator, with the mechanical ventilation time lasting from 5 to 46 days. Once the adenovirus was diagnosed, all patients were treated with intravenous gamma globulin, three of whom were treated with intravenous ganciclovir and ribavirin. Six cases were discharged and one patient died. Conclusion: Adult severe adenovirus pneumonia occurs most common in young and middle-aged males. mNGS can identify the pathogen rapidly. Active and effective treatment is necessary.

Key words： adenovirus severe community-acquired pneumonia adult

通讯作者: 李玉苹，教授，Email：wzliyp@163.com。

作者简介: 张胜男（1994-），女，浙江金华人，硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2020.03.013 或 https://xb.wmu.edu.cn/CN/Y2020/V50/I3/232

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