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·胸部疾病·

支气管肺泡灌洗液联合血清学诊断免疫正常婴儿巨细胞病毒肺 炎分析

作者:王 姝1,2 冯 斌1

所属单位:1.深圳市第六人民医院儿科 (广东 深圳 518052) 2.深圳市第六人民医院病案统计室 (广东 深圳 518052)

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摘要

目的 免疫正常婴儿巨细胞病毒(CMV)肺炎的临床特点。方法 对免疫功能正常,经支气管肺泡灌洗液CMV-DNA和血 清CMV-IgM检测,并排除合并其他病原感染,确诊为CMV肺炎的患儿进行分析。结果 13例患儿纳入,男:女=8:5; 年龄1-3个月10例;入院时病程>2周7例。咳嗽100%;气促76.9%;喘息61.5%;发绀23%;发热30.8%;肺部湿性啰音 92.3%;部分伴肝功能和听力异常。血常规淋巴细胞升高,84.6% CRP正常。胸部CT提示4例实质改变,6例间质改 变,3例实质合并间质改变。12例予不同疗程更昔洛韦治疗,1例仅给予丙种球蛋白治疗。所有病人临床改善,影像 学病灶吸收好转。治疗期间1例出现可逆性外周血粒细胞降低。结论 免疫正常婴儿CMV肺炎临床表现为病程较长的 咳嗽,喘息、气促症状较常见,可伴肺外症状。影像学可为间质或实质改变;更昔洛韦治疗安全有效。

Objective To investigate the clinical characteristics of cytomegalovirus(CMV) pneumonia in immunocompetent infants. Methods Analyze the clinical datas of 10 infants with CMV pneumonia was diagnosed by CMV-DNA quantitative detection in bronchoalveolar lavage fluid plus CMV-IgM detection by ELISA, and cases co-infection with other pathogens were excluded. Results Thirteen cases were recruited , 8 cases were male, 10 cases aged ranged from 1 to 3 months, 7 cases have a course more than two weeks on admission. All had cough; 76.9% cases had tachypnea; 61.5% cases had wheezing; 23% cases had cyanosis and 30.8% cases had fever 92.3% cases had rales. Some cases had liver function and audition damage. The lymphocytes were increased, CRP were normal in 84.6% cases. There was no child with jaundice, hepatosplenomegaly, rash or malnutrition. The chest Computed Tomography showing consolidation in 4 cases and interstitial lesions in 6 cases and mixed in 3 cases. Except one treated with immunoglobulin, 12 cases treated with Ganciclovir in different course, all alleviated the symptom and lesions in X-ray. Only one case had reversible neutropenia during treat. Conclusion CMV pneumonia in immunocompetent infants had long course of cough, probably accompany with wheezing and tachypnea and might had damage in other systems. The X-ray showing could be consolidation or interstitial lesions. The Ganciclovir is safe and effective for CMV pneumonia.

【关键词】巨细胞病毒;肺炎;免疫正常;支气管肺泡灌洗液;婴儿

【中图分类号】R563.1

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2016.02.006

前言

巨细胞病毒(Cytomegalovirus,CMV)感染可导致 多系统损害[1,2],是免疫缺陷个体的重要病原[3]。在 免疫正常个体,巨细胞病毒肺炎也可发生[4]。但在我 国,CMV潜伏感染相当普遍,确诊CMV肺炎是个难题。 一般认为,CMV-IgM阳性提示现症感染,而支气管肺泡灌洗液(Bronchoalveolar lavage fluid,BALF)的 病原检测可代表下呼吸道病原。因此本研究联合BALF CMV-DNA定量PCR和血清CMV-IgM抗体ELISA检测,并除 外常见肺炎病原的合并感染,旨在探讨免疫正常婴儿 CMV肺炎的临床特点与治疗。