摘要
目的通过回顾婴儿巨细胞病毒(CMV)性肺炎的临床症状、实验室结果、影像学检查及治疗效果等,探讨婴儿CMV肺炎的临床与诊治特点、提高临床儿科医师对该病的认识。方法分析2015年10月至2020年1月本院南沙分院儿科及新生儿科收治的40例婴儿CMV肺炎。并分别对其治疗前后临床资料、临床症状、实验室、影像学等结果及治疗效果进行汇总分析。临床资料包括患儿的性别、年龄及发病季节等;实验室检查包括血常规、肝功能、血CMV-免疫球蛋白M(IgM)抗体及血CMV-DNA;影像学资料包括胸部平片、肺部CT和头颅核磁共振、脑干听觉诱发电位、视网膜病变筛查等;并在肺炎的基础治疗下均给予更昔洛韦注射液抗病毒治疗,并进行临床疗效分析。结果40例患儿中,男性20例(50.0%),女性20例(50.0%);年龄1~6个月有37例(92.5%);春季发病5例(12.5%)、夏季12例(30.0%)、秋季13例(32.5%)、冬季10例(25.0%)。临床表现为咳嗽38例(95.0%)、发热6例(15.0%)、喘息10例(25.0%)、呼吸困难5例(12.5%),肺部听诊可闻及啰音有17例(42.5%)。所有患儿均接受更昔洛韦抗病毒治疗,治疗后血常规、肝功能等生化指标明显改善,血CMV-DNA定量治疗后显著降低[(0.058±0.021)×10^(3)拷贝/ml比(12.400±7.030)×10^(3)拷贝/ml](P<0.05),血CMV-IgM抗体转阴率为95.0%(38/40),治疗总有效率为92.5%(37/40)。治疗期间未见明显药物不良反应。结论本研究发现婴儿CMV肺炎主要发病年龄为6个月以内,主要发病季节为夏秋冬季;主要症状为咳嗽、喘息和发热;合并肺外器官损害最常见的有肝脏和血液系统,少数有听力、视力和脑发育的损害;CMV感染的治疗首选更昔洛韦抗病毒治疗,疗效好,安全有效,不良反应少,值得临床推广使用。
Objective By reviewing the clinical symptoms,laboratory results,imaging findings,and therapeutic effects of infantile cytomegalovirus(CMV)pneumonia,and analyzing the clinical features of diagnosis and treatment of CMV pneumonia,to improve the understanding on the disease among clinical pediatricians.Methods A total of 40 infants with CMV pneumonia admitted to the Departments of Pediatrics and Neonatology of Nansha Branch of our hospital from October 2015 to January 2020 were analyzed.The clinical data,clinical symptoms,laboratory results,imaging findings before and after treatment,and therapeutic effects were summarized and analyzed.The clinical data included gender,age,and season of onset.Laboratory tests included blood routine,liver function,blood CMV-IgM antibody,and blood CMV-DNA.Imaging data included chest radiograph,lung CT,cranial MRI,brainstem auditory evoked potential,and retinopathy screening.In addition,ganciclovir injection was given as an antiviral therapy for pneumonia,and the clinical efficacy was analyzed.Results Among the 40 cases,there were 20 males(50.0%)and 20 females(50.0%),37 cases(92.5%)with the age of 1-6 months old;seasonal distribution:5 cases of onset(12.5%)in spring,12 cases(30.0%)in summer,13 cases(32.5%)in autumn,and 10 cases(25.0%)in winter.The clinical manifestations were cough in 38 cases(95.0%),fever in 6 cases(15.0%),wheeze in 10 cases(25.0%),and dyspnea in 5 cases(12.5%),and rales were observed in lung auscultation in 17 cases(42.5%).All infants were given ganciclovir injection as an antiviral therapy,the blood routine,liver function,and other biochemical indexes improved significantly after treatment,the blood CMV-DNA quantitation significantly reduced after treatment[(0.058±0.021)×10^(3) copies/ml vs.(12.400±7.030)×10^(3) copies/ml](P<0.05),the negative conversion ratio of blood CMV-IgM antibody was 95.0%(38/40),the total treatment effective rate was 92.5%(37/40),and no obvious adverse drug reactions during the treatment.Conclusions In this study,it is found that the main onset age of CMV pneumonia in infants is less than 6 months old,and the main onset seasons are summer,autumn,and winter.The main symptoms are cough,wheeze,and fever.The most common extrapulmonary organ damage occurs in liver and blood system,and a few patients have hearing,vision,and brain development damage.Ganciclovir antiviral therapy is the first choice for the treatment of CMV infection,which has good curative effect and fewer adverse reactions,is safe and effective,and is worthy of clinical promotion.
作者
杨家勇
于力
翁志媛
Yang Jiayong;Yu Li;Weng Zhiyuan(Department of Pediatrics,Guangzhou First People's Hospital,Guangzhou Medical University,Guangzhou 511400,China)
出处
《国际医药卫生导报》
2021年第12期1825-1829,共5页
International Medicine and Health Guidance News
关键词
巨细胞病毒
肺炎
更昔洛韦
婴儿
Cytomegalovirus
Pneumonia
Ganciclovir
Infants
