儿童3型腺病毒肺炎预后影响因素分析

doi:10.12372/jcp.2025.24e1412

临床儿科杂志 ›› 2025, Vol. 43 ›› Issue (9): 686-691.doi: 10.12372/jcp.2025.24e1412

儿童3型腺病毒肺炎预后影响因素分析

项琳娟¹, 陈雪欣², 贾艳会², 吴宇航², 丛鑫², 李伟³, 陈盈盈³, 陈笋⁴, 黄丽素²()

1.上海交通大学医学院附属新华医院（上海 200092）
2.浙江大学医学院附属儿童医院感染科国家儿童健康与疾病临床医学研究中心（浙江杭州 310052）
3.浙江大学医学院附属儿童医院实验检验中心国家儿童健康与疾病临床医学研究中心（浙江杭州 310052）
4.上海交通大学医学院附属新华医院小儿心血管科（上海 200092）

收稿日期:2024-12-31 录用日期:2025-07-10 出版日期:2025-09-15 发布日期:2025-08-27
通讯作者: 黄丽素电子信箱：lisuhuang@zju.edu.cn
基金资助:
国家重点研发计划(2021YFC2701800);国家重点研发计划(2021YFC2701801)

Prognostic factors analysis of adenovirus type 3 pneumonia in children

XIANG Linjuan¹, CHEN Xuexin², JIA Yanhui², WU Yuhang², CONG Xin², LI Wei³, CHEN Yingying³, CHEN Sun⁴, HUANG Lisu²()

1. Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
2. Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang, China
3. Department of Lab Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, Zhejiang, China
4. Department of Pediatric Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China

Received:2024-12-31 Accepted:2025-07-10 Published:2025-09-15 Online:2025-08-27

摘要/Abstract

摘要：

目的分析呼吸道3型腺病毒感染患儿的临床特征以及儿童3型腺病毒肺炎发生的影响因素。方法回顾性分析2024年1月至10月医院感染科收治的呼吸道3型腺病毒核酸阳性患儿的临床资料。通过多因素logistic回归分析3型腺病毒肺炎发生的可能影响因素。结果共纳入159例3型腺病毒感染患儿，其中男87例、女72例，中位年龄为59.0（41.0~81.0）个月。多因素logistic回归分析显示扁桃体渗出、C反应蛋白水平升高是儿童3型腺病毒肺炎发生的独立保护因素（P<0.05），而咳嗽、咳痰和D二聚体水平升高是3型腺病毒肺炎发生的独立危险因素（P<0.05）。结论在儿童呼吸道腺病毒感染的早期，扁桃体渗出可能预示较轻的肺部症状，提示扁桃体在3型腺病毒急性感染发病机制中的重要免疫作用。

关键词: 3型腺病毒, 肺炎, 扁桃体渗出, 儿童

Abstract:

Objective To analyze the clinical characteristics of children with respiratory adenovirus type 3 infection and the influencing factors of adenovirus type 3 pneumonia in children. Methods A retrospective analysis was conducted on the clinical data of children with respiratory adenovirus type 3 infection admitted to the hospital's infectious disease department from January to October 2024. The possible influencing factors of the occurrence of adenovirus type 3 pneumonia were analyzed through multivariate logistic regression. Results A total of 159 children (87 boys and 72 girls) with adenovirus type 3 infection were included, with a median age of 59.0 (41.0-81.0) months. Multivariate logistic regression analysis showed that tonsillar exudation and elevated CRP level were independent protective factors for adenovirus type 3 pneumonia in children (P<0.05), while cough, expectoration and elevated D-dimer level were independent risk factors for adenovirus type 3 pneumonia (P<0.05). Conclusions In the early course of respiratory adenovirus type 3 infection in children, tonsillar exudation may indicate mild pulmonary symptoms, suggesting that the tonsils may play an important defensive role in the immune response of acute adenovirus infection.

Key words: adenovirus type 3, pneumonia, tonsillar exudation, child

中图分类号:

项琳娟, 陈雪欣, 贾艳会, 吴宇航, 丛鑫, 李伟, 陈盈盈, 陈笋, 黄丽素. 儿童3型腺病毒肺炎预后影响因素分析[J]. 临床儿科杂志, 2025, 43(9): 686-691.

XIANG Linjuan, CHEN Xuexin, JIA Yanhui, WU Yuhang, CONG Xin, LI Wei, CHEN Yingying, CHEN Sun, HUANG Lisu. Prognostic factors analysis of adenovirus type 3 pneumonia in children[J]. Journal of Clinical Pediatrics, 2025, 43(9): 686-691.

图/表 2

表1

表2

参考文献 31

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项目	HAdV-B3非肺炎组(n=73)	HAdV-B3肺炎组(n=86)	统计量	P
年龄[M(P₂₅~P₇₅)]/月	59.6(44.0~79.0)	56.5(35.5~83.5)	Z=0.96	0.336
男性[n(%)]	33(45.21)	54(73.97)	χ²=4.93	0.026
热峰[M(P₂₅~P₇₅)]/℃	40.0(39.2~40.2)	39.6(39.0~40.0)	Z=2.02	0.044
发热天数[M(P₂₅~P₇₅)]/d	6.0(5.0~7.9)	6.0(4.8~8.0)	Z=0.60	0.547
基础疾病[n(%)]	12(16.4)	13(15.1)	χ²=0.05	0.819
入院临床表现[n(%)]
咳嗽、咳痰	51(69.9)	82(95.3)	χ²=16.93	<0.001
喘息	3(4.1)	21(24.4)	χ²=11.17	0.001
扁桃体渗出	24(32.9)	13(15.1)	χ²=6.98	0.008
腹痛	19(26.0)	12(14.0)	χ²=3.67	0.055
腹泻	8(11.0)	7(8.1)	χ²=0.37	0.544
呕吐	26(35.6)	19(22.1)	χ²=3.56	0.059
头痛	8(11.0)	4(4.7)	χ²=1.44	0.230
皮疹、红斑	6(8.2)	6(7.0)	χ²=0.09	0.768
颈部淋巴结肿大	20(27.4)	9(10.5)	χ²=7.59	0.006
肝脾肿大	3(4.1)	6(7.0)	χ²=0.19	0.663
入院实验室检查[M(P₂₅~P₇₅)]
血常规
白细胞计数×10⁹·L^-1	9.6(6.3~13.8)	8.2(5.7~12.4)	Z=1.37	0.169
中性粒细胞计数×10⁹·L^-1	6.5(3.3~10.4)	4.8(2.7~8.4)	Z=1.87	0.061
单核细胞计数×10⁹·L^-1	0.7(0.4~1.2)	0.6(0.5~1.2)	Z=0.75	0.453
淋巴细胞计数×10⁹·L^-1	2.0(1.3~3.3)	2.3(1.8~3.4)	Z=1.68	0.093
血红蛋白/g·L^-1	117.0(111.0~123.0)	117.5(113.8~123.0)	Z=0.67	0.504
血小板计数×10⁹·L^-1	251.0(216.0~325.5)	308.0(253.3~371.0)	Z=2.72	0.007
CRP/mg·L^-1	28.2(10.1~53.0)	12.3(4.7~30.6)	Z=2.92	0.004
PCT/ng·mL^-1	0.4(0.2~0.8)	0.2(0.1~0.6)	Z=2.19	0.028
红细胞沉降率/mm·h^-1	22.0(12.4~31.4)	22.5(14.9~34.2)	Z=0.58	0.565
ALT/U·L^-1	13.5(11.0~17.3)	13.0(11.0~17.0)	Z=0.09	0.931
LDH/U·L^-1	322.5(240.0~698.5)	289.0(241.5~396.5)	Z=1.61	0.106
铁蛋白/μg·L^-1	89.6(71.9~111.8)	100.5(70.6~126.0)	Z=0.97	0.331
D-二聚体/mg·L^-1	0.3(0.2~0.4)	0.4(0.3~0.5)	Z=3.79	<0.001
纤维蛋白原/g·L^-1	3.8(3.5~4.3)	3.8(3.1~4.4)	Z=0.83	0.409

因素	偏回归系数	标准误	χ²值	OR(95%CI)	P
咳嗽、咳痰	3.76	1.02	13.60	43.10(5.83~318.64)	<0.001
扁桃体渗出	－1.47	0.50	8.87	0.23(0.09~0.60)	0.003
CRP	－0.02	0.01	7.53	0.98(0.96~0.99)	0.006
D-二聚体	3.52	1.17	9.11	33.91(3.44~334.40)	0.003
常量	－3.42	1.19	8.22	－	0.004

儿童3型腺病毒肺炎预后影响因素分析

Prognostic factors analysis of adenovirus type 3 pneumonia in children

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