儿童病毒性肺炎临床思考

doi:10.12372/jcp.2022.22e0130

Abstract

Abstract:

Viral pneumonia plays an important role in community acquired pneumonia in children, which is also the main cause of severe pneumonia in children under 5 years old of age. This paper reviews some clinical problems in children with viral pneumonia, then realigns the clinical features and laboratory tests of viral pneumonia to restructure the understanding of the characteristics of viral pneumonia in children for achieving early recognition and intervention.

Key words: viral pneumonia in children, severe pneumonia, pathogens, laboratory detection

DONG Xiaoyan, MENG Chaoyue. Clinical consideration of viral pneumonia in children[J].Journal of Clinical Pediatrics, 2022, 40(8): 561-565.

Figures/Tables 2

病毒		易感人群	流行季节	常见症状	重症表现	影像学	炎症反应
DNA病毒	HAdV	6月龄~ 5岁	北方冬季,南方春夏季	稽留高热,伴咳嗽、喘息	中毒症状重、喘憋明显、其他系统并发症	双肺多发磨玻璃密度影伴斑片状实变影,呈叶段分布,多见肺气肿或透亮不均匀的“马赛克征”,重者有积液	IFN-γ、IL-6、TNF-α等升高
DNA病毒	BoV	<3岁	秋冬季多见,部分地区长年散发	发热、咳嗽、喘息	呼吸困难,呼吸衰竭,肺外脏器受累相对轻	多见双肺受累,可见斑片影、实变影	IL-6、TNF-α、IL-10升高,可有Th1/Th2失衡
RNA病毒	RSV	<5岁	冬春季	发热、咳嗽、喘息	气促,发绀喂养困难,呼吸困难	双肺非对称分布的小叶中心小结节、肺实变、树芽征、磨玻璃密度影、支气管壁增厚	IL-1β、IL-8、TNF-α、IFN-γ、IL-10等升高
	IV	普遍易感	冬春季	发热、咳嗽、咽痛、全身肌肉酸痛等	肺外并发症	单侧或双侧弥漫性磨玻璃密度影,常分布在支气管血管束周围及胸膜下	炎症因子风暴
	PIV	<5岁	不同亚型流行季节不同	发热、咳嗽,部分可有喘息	单独致病肺实变或者重症肺炎病例少见,混合感染容易加重病情	双肺可见沿支气管血管束分布的多发斑片状实变影及磨玻璃密度影	炎症因子风暴
	COVID-19	儿童感染率低	—	发热、咳嗽,部分伴味觉、嗅觉丧失等	呼吸困难、低氧血症、部分可出现川崎病、血管炎表现	早期CT多无表现,进展期可表现为多发磨玻璃密度影、实变影、结节影,重症期双肺弥漫性病变	炎症因子风暴
	HRV	—	—	鼻塞、流涕咳嗽,部分咳嗽发热、喘息	小婴儿可有气促、发绀,混合感染容易加重病情	支气管肺炎为主,重症双肺可见斑片状实变影伴多灶性磨玻璃密度影和小叶间隔增厚	炎症因子风暴

References 24

[1]	Tramper-stranders GA. Childhood community-acquired pneumonia: a review of etiology- and antimicrobial treatment studies[J]. Paediatr Respir Rev, 2018, 26: 41-48. doi: S1526-0542(17)30070-2 pmid: 28844414
[2]	Pneumonia Etiology Research for Child Health PERCH Study Group. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study[J]. Lancet, 2019, 394(10200): 757-779. doi: 10.1016/S0140-6736(19)30721-4
[3]	陆芸芸, 罗蓉, 符州. 儿童重症社区获得性肺炎病原体分布及细菌耐药情况分析[J]. 中国当代儿科杂志, 2017, 19(9): 983-988.
[4]	中华医学会儿科学分会呼吸学组, 中华儿科杂志编辑委员会. 儿童社区获得性肺炎管理指南(2013修订)(上)[J]. 中华儿科杂志, 2013, 51(10): 745-752.
[5]	中华人民共和国国家健康委员会, 国家中医药局. 儿童社区获得性肺炎诊疗规范(2019年版)[J]. 中华临床感染病杂志, 2019, 12(1): 6-13.
[6]	Lai CC, Shih TP, Ko WC, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges[J]. Int J Antimicrob Agents, 2020, 55(3)
[7]	Jobran S, Kattan R, Shamaa J, et al. Adenovirus respiratory tract infections in infants: a retrospective chart-review study[J]. Lancet, 2018, 391(Suppl 2): S43. doi: 10.1016/S0140-6736(18)30409-4
[8]	中华人民共和国国家卫生健康委员会, 国家中医药管理局. 儿童腺病毒肺炎诊疗规范(2019年版)[J]. 中华临床感染病杂志, 2019, 12(3): 161-166.
[9]	张新萍, 杨梅雨, 周雄, 等. 儿童重症7型腺病毒肺炎45例临床分析[J]. 中国当代儿科杂志, 2020, 22(5): 429-434.
[10]	任康轶, 任洛, 邓昱, 等. 2013-2018年重庆地区2066例急性下呼吸道感染住院患儿呼吸道合胞病毒流行特征分析[J]. 中国当代儿科杂志, 2021, 23(1): 67-73.
[11]	吴喜蓉, 刘钢, 钱素云, 等. 住院儿童社区获得性流感病毒肺炎临床特点分析[J]. 中华实用儿科临床杂志, 2019, 34(2): 129-133.
[12]	中华人民共和国国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案(试行第八版修订版)[J]. 中华临床感染病杂志, 2021, 14(2): 81-88.
[13]	Cui X, Zhao Z, Zhang T, et al. A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19)[J]. J Med Virol, 2021, 93(2): 1057-1069. doi: 10.1002/jmv.26398
[14]	Abrams JY, Oster ME, Godfred-Cato SE, et al. Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study[J]. Lancet Child Adolesc Health, 2021, 5(5): 323-331. doi: 10.1016/S2352-4642(21)00050-X
[15]	中华中医药学会儿童肺炎协同创新共同体, 中华医学会儿科学分会临床药理学组, 中国实用儿科杂志编辑委员会. 儿童病毒性肺炎中西医结合诊治专家共识(2019年制定)[J]. 中国实用儿科杂志, 2019, 34(10): 801-807.
[16]	中国研究型医院学会呼吸病学专业委员会, 成人呼吸系统感染性疾病病原学诊断专家意见编写组. 成人呼吸系统感染性疾病病原学诊断专家意见[J]. 中华结核和呼吸杂志, 2020, 43(9): 757-764.
[17]	中华医学会儿科学分会呼吸学组呼吸道感染协作组, 中国实用儿科杂志编辑委员会. 儿童呼吸道感染微生物检验标本采集转运与检测建议(病毒篇)[J]. 中国实用儿科杂志, 2018, 33(9): 657-662.
[18]	Jain S, Williams DJ, Arnold SR, et al. Community-acquired pneumonia requiring hospitalization among U.S. children[J]. N Engl J Med, 2015, 372(9): 835-845. doi: 10.1056/NEJMoa1405870
[19]	Nolan VG, Arnold SR, Bramley AM, et al. Etiology and impact of coinfections in children hospitalized with community-acquired pneumonia[J]. J Infect Dis, 2018, 218(2): 179-188. doi: 10.1093/infdis/jix641
[20]	Fajgenbaum DC, June CH. Cytokine storm[J]. N Engl J Med, 2020, 383(23): 2255-2273. doi: 10.1056/NEJMra2026131
[21]	Agarwal A, Rochwerg B, Lamontagne F, et al. A living WHO guideline on drugs for COVID-19[J]. BMJ, 2020, 370: m3379.
[22]	邹映雪, 张旭冉. 儿童重症肺炎生物标志物研究及应用进展[J]. 中国实用儿科杂志, 2022, 37(2): 92-96.
[23]	国家呼吸系统疾病临床医学研究中心, 中华医学会儿科学分会呼吸学组, 中国医师协会呼吸医师分会儿科呼吸工作委员会, 等. 儿童呼吸道合胞病毒感染诊断, 治疗和预防专家共识[J]. 中华实用儿科临床杂志, 2020, 35(4): 241-250.
[24]	中华人民共和国国家卫生健康委员会办公厅, 中华人民共和国国家中医药管理局办公室. 新型冠状病毒肺炎诊疗方案(试行第九版)[J]. 中国医药, 2022, 17(4): 481-487.

检测方法		优点	缺点	成本和时间
病原培养		特异度高,金标准	培养条件要求高、耗时长,检测环节较多,操作不易标准化,对人员技术要求较高,标本中病原体量少时,易导致假阴性	成本较高,最短可在5天内检测到阳性标本
抗原检测	直接免疫荧光法	快速、特异度较高,且可用于疾病的早期诊断	灵敏度较低,样本来源与质量、取材时机均影响结果;操作繁琐	成本适中,最快30分钟至2小时出结果
抗原检测	胶体金免疫分析、免疫层析法	操作检点、快速,可实现床旁检测	二抗可能导致非特异度免疫,灵敏度较低,需要足够的样本量	成本适中,最快30分钟至2小时出结果
抗体检测核酸检测	间接免疫荧光法酶联免疫吸附法	快速快速,批量筛查	回顾性诊断,对疾病早期诊断没太大帮助回顾性诊断,特异度不高,假阳性多	检测成本各不相同,最短数分钟,但间隔2周收集的配对血清才能达到最佳检测结果
		灵敏度及特异度均很高	价格稍高于抗原抗体检测,远低于高通量测序	检测类型不同,试剂成本不同,可多重检测减低成本,快速可以数分钟至数小时内出结果
高通量测序		灵敏度高,可检查出未知病原体	价格昂贵,报告解读要求高,需要专业人员,数据库的完善。	成本高,一般需要1天至数天

Clinical consideration of viral pneumonia in children

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