Zhang Hua-Yong, Li Chang-Jian, Long Yuan, Sun Dong-Ming, Wang Rui-Geng, Zhang Yong
Department of Cardiology, Wuhan Children's Hospital/Wuhan Maternal and Child Healthcare Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2020 Jul;22(7):744-748. doi: 10.7499/j.issn.1008-8830.2003080.
To study the clinical features of children with severe adenovirus pneumonia (SAP) and hemophagocytic syndrome (HPS).
A retrospective analysis was performed from the chart review data of 30 children with SAP and HPS who were admitted from January 2014 to June 2019. According to the prognosis, the children were divided into a good prognosis group (n=18) and a poor prognosis group (n=12).
Among the 30 children with SAP and HPS, the ratio of male to female was 2:1. The median age of onset was 1 year and 3 months (range 3 months to 5 years), and the mean course of fever was 19±7 d. Of the 30 children, 28 (93%) experienced disease onset in January to June. High-throughput gene detection of serum pathogens showed that 16 (53%) children were positive for human adenovirus type 7 (HAdV-7), and the other 14 (47%) children were positive for HAdV antigen based on immunofluorescence assay for throat swab, with unknown type. Of all 30 children, 29 (97%) had respiratory complications, 24 (80%) had cardiovascular complications, 16 (53%) had gastrointestinal complications, and 9 (30%) had toxic encephalopathy. Eighteen children (60%) improved or recovered and 12 (40%) did not recover (3 died). Compared with the good prognosis group, the poor prognosis group had a significantly longer course from onset to diagnosis of HPS (P<0.05), significantly higher levels of fibrinogen and tumor necrosis factor-α (P<0.05), and a significantly lower level of interferon-γ (P<0.05). The mean follow-up time was 6±2 months; 11 (41%) children recovered, 1 (4%) experienced recurrence of HPS, and 15 (56%) had the sequela of post-infectious bronchiolitis obliterans (PIBO).
HPS may be observed in children with SAP, and PIBO is the most common sequela of SAP.
研究重症腺病毒肺炎（SAP）合并噬血细胞综合征（HPS）患儿的临床特征。
对2014年1月至2019年6月收治的30例SAP合并HPS患儿的病历资料进行回顾性分析。根据预后情况，将患儿分为预后良好组（n = 18）和预后不良组（n = 12）。
30例SAP合并HPS患儿中，男女比例为2∶1。发病年龄中位数为1岁3个月（范围3个月至5岁），发热平均病程为19±7天。30例患儿中，28例（93%）于1月至6月发病。血清病原体高通量基因检测显示，16例（53%）患儿7型人腺病毒（HAdV-7）阳性，另外14例（47%）患儿经咽拭子免疫荧光法检测HAdV抗原阳性，但型别不明。30例患儿中，29例（97%）有呼吸并发症，24例（80%）有心血管并发症，16例（53%）有胃肠道并发症，9例（30%）有中毒性脑病。18例（60%）患儿好转或康复，12例（40%）未康复（3例死亡）。与预后良好组相比，预后不良组从发病到诊断为HPS的病程明显更长（P<0.05），纤维蛋白原和肿瘤坏死因子-α水平明显更高（P<0.05），干扰素-γ水平明显更低（P<0.05）。平均随访时间为6±2个月；11例（41%）患儿康复，1例（4%）HPS复发，15例（56%）有感染后闭塞性细支气管炎（PIBO）后遗症。
SAP患儿可能出现HPS，PIBO是SAP最常见的后遗症。
