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目的了解人类博卡病毒(HBoV)感染所致儿童重症肺炎的流行病学及临床特点。方法对2009年1月-2010年12月本院PICU 27例重症HBoV肺炎患儿和106例重症RSV肺炎患儿的流行病学和临床特点进行比较分析。结果重症HBoV肺炎患儿年龄(1.26±0.58)岁,显著大于重症RSV肺炎患儿[(0.49±0.57)岁](P<0.05)。重症HBoV肺炎患儿秋冬季发病占全年的66.7%(18/27例),与重症RSV肺炎患儿的88.7%(94/106例)比较差异无统计学意义;重症HBoV组66.7%(18/27例)的患儿有发热,高于重症RSV肺炎患儿的36.8%(39/106例);40.7%(11/27)重症HBoV肺炎患儿有喘息,低于重症RSV肺炎患儿的92.5%(98/106例)。100%(27/27例)重症HBoV肺炎患儿伴有咳嗽,11.1%(3/27例)伴有腹泻,无抽搐和胃肠道出血发生,66.7%(18/27例)患儿入院时氧合指数低于300 mmHg(1 mmHg=0.133 kPa),14.8%(4/27例)予机械通气,通气时间为(3.93±1.56)d,但无急性呼吸窘迫综合征(ARDS)发生,无死亡病例;48.1%(13/27例)患儿CK-MB升高,7.4%(2/27例)患儿肌钙蛋白(cTnI)升高,14.8%(4/27例)患儿AST、ALT升高,44.4%(12/27例)患儿CRP升高;影像学检查77.8%(21/27例)患儿双肺受累,63.0%(17/27例)表现为肺门周围纹理粗重,88.9%(24/27例)表现为肺气肿,55.6%(15/27例)有小斑片影,14.8%(4/27例)有大范围病灶,14.8%(4/27例)出现肺不张,未出现胸腔积液和肺气漏征象。结论苏州地区重症HBoV肺炎多见于2岁以下患儿,秋冬季为发病高峰,以发热、咳嗽、喘息和呼吸困难为主要表现,可出现低氧血症,但无ARDS发生,影像学表现以肺气肿和两肺门周围纹理改变为主,较少出现胸腔积液和肺气漏征象。
Objective To understand the epidemiology and clinical features of severe pneumonia in children with Bocavirus (HBoV) infection. Methods The epidemiological and clinical features of 27 children with severe HBoV pneumonia and 106 severe RSV pneumonia in PICU from January 2009 to December 2010 were compared. Results The age of children with severe HBoV pneumonia (1.26 ± 0.58) years old was significantly higher than that of children with severe RSV pneumonia [(0.49 ± 0.57) years old] (P <0.05). The incidence of autumn and winter in children with severe HBoV pneumonia accounted for 66.7% (18/27) of the whole year, which was not significantly different from that of 88.7% (94/106 cases) of severe RSV pneumonia. In severe HBoV group, 66.7% (18/18) / 27 cases) had fever, which was higher than 36.8% (39/106 cases) of children with severe RSV pneumonia; 40.7% (11/27) children with severe HBoV pneumonia had wheeze, which was lower than that of children with severe RSV pneumonia 92.5% (98/106 cases). 100% (27/27 cases) of children with severe HBoV pneumonia had cough, 11.1% (3/27 cases) with diarrhea, no convulsions and gastrointestinal bleeding, while 66.7% (18/27) children were admitted to hospital Oxygenation index was less than 300 mmHg (1 mmHg = 0.133 kPa), 14.8% (4/27 cases) were given mechanical ventilation and ventilation time was (3.93 ± 1.56) days, but no ARDS occurred. CK-MB was increased in 48.1% (13/27 cases), elevated cTnI in 7.4% (2/27 cases), AST in 14.8% (4/27 cases) ALT increased, and CRP increased in 44.4% (12/27 cases) of children. Radiographic examination included 77.8% (21/27 cases) of children with bilateral lung involvement and 63.0% (17/27 cases) , 88.9% (24/27 cases) showed emphysema, 55.6% (15/27 cases) had small patches, 14.8% (4/27 cases) had extensive lesions, 14.8% (4/27 cases) Atelectasis appears, there is no signs of pleural effusion and pulmonary air leakage. Conclusions Severe HBoV pneumonia in Suzhou is more common in children under 2 years of age with peak incidence in autumn and winter, with fever, cough, wheezing and dyspnea as main manifestations. Hypoxemia may occur but no ARDS occurs. Emphysema and the two lung door around the main texture changes, less signs of pleural effusion and pulmonary air leakage.