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目的:比较不同载量人博卡病毒(HBo V)肺炎患儿的临床特征及肺功能指标,了解HBo V载量与肺炎的关系,探讨HBo V致病机制。方法:选取2013年1-11月因支气管肺炎在苏州大学附属儿童医院呼吸科住院治疗的婴幼儿1 653例,应用荧光定量PCR法检测患儿痰液中HBo V-DNA,检出HBo V阳性患儿122例,其中高病毒载量组(HBo V-DNA≥1×104copies/m L)65例,低病毒载量组(HBo V-DNA<1×104copies/m L)57例,比较两组患儿的临床特征;高载量组36例、低载量组28例进行肺功能检测,观测患儿潮气呼吸流速-容量环(TBFV环)形态及其各项指标变化。结果:不同HBo V载量感染组间临床症状比较,除喘息外,其他症状发生率差异均无统计学意义。但肺功能比较,高病毒载量组与低病毒载量组到达峰流速时间(TPTEF)、到达峰流速时呼出气量(VPTEF)及反映小气道功能指标到达峰流速时间/呼气时间(TPTEF/TE)、到达峰流速时呼出气量/呼气容积(VPTEF/VE)、剩余25%潮气量时呼气流速(TEF 25%)及剩余25%潮气量时的呼气流速/呼气峰速(TEF 25%/PF)均明显降低,且高病毒载量组上述值下降更明显,差异均有统计学意义(P<0.05);高、低病毒载量组中代表大气道功能的指标平均呼气流速/平均吸气流速(ME/MI)与正常对照组比较差异均无统计学意义。从TBFV环形态上看,HBo V肺炎患儿呼气峰左移,呼气相降支呈波谷样凹陷,且高病毒载量组凹陷更加明显。结论:苏州地区HBo V肺炎住院患儿存在一定的肺功能损害,主要表现为小气道阻塞性功能障碍。病毒载量与临床症状及肺功能损害程度相关,高载量组喘息发作率高,小气道损害明显。
OBJECTIVE: To compare the clinical features and lung function of children with different loading Bocavirus (HBoV) pneumonia to understand the relationship between HBo V load and pneumonia and to explore the pathogenesis of HBoV. Methods: From January to November 2013, 1 653 infants and young children hospitalized for respiratory diseases due to bronchial pneumonia in Children’s Hospital Affiliated to Soochow University were enrolled. Fluorescent quantitative PCR was used to detect HBo V-DNA in sputum from children and HBoV positive There were 122 cases of children, including 65 cases of high viral load group (HBo V-DNA≥1 × 104copies / m L) and 57 cases of low viral load group (HBo V-DNA <1 × 104copies / m L) The clinical features of the children were observed. The high-load group (36 cases) and the low-load group (28 cases) were performed pulmonary function test to observe the changes of the morphology and indexes of the tidal respiratory flow-volume ring (TBFV) in children. Results: There was no significant difference in the incidence of other symptoms except wheezing between different HBoV infection groups. However, pulmonary function, TPTEF, VPTEF, and TPTEF / PDT were higher in high viral load group and low viral load group, TE, expiratory volume / expiratory volume at peak flow rate (VPTEF / VE), expiratory flow rate at 25% tidal volume (TEF 25%), and expiratory flow rate / peak expiratory flow rate at 25% tidal volume TEF 25% / PF) were significantly lower, and the above-mentioned values of high viral load decreased more significantly, the difference was statistically significant (P <0.05); high and low viral load group representative of the function of the average airway call Gas flow / mean inspiratory flow rate (ME / MI) compared with the normal control group showed no significant difference. From the morphological observation of TBFV, the expiratory peak of left lung in children with HBo V pneumonia was shifted to the left, and the expiratory phase of the expiratory phase was trough-like, and the sag in the high viral load group was more obvious. Conclusion: Children with HBo V pneumonia in Suzhou area have certain lung function impairment, which is mainly manifested as small airway obstructive dysfunction. Viral load and clinical symptoms and the degree of lung damage, high-load group wheezing high incidence of small airway damage significantly.