探讨呼吸道合胞病毒(RSV)、甲型流感病毒(FV)和腺病毒(ADV)感染导致的儿童重症社区获得性肺炎(CAP)的临床特征差异。

选择2005年1月1日至2008年1月1日在广州市妇女儿童医疗中心住院治疗的107例重症CAP患儿的临床病历资料为研究对象。将其按照感染病毒类型分别纳入RSV组(n＝69，感染RSV)，FV组(n＝12，感染FV)及ADV组(n＝26，感染ADV)。肺炎及重症CAP的诊断参考"儿童社区获得性肺炎管理指南(试行)"标准。3组患儿年龄、性别及住院时间比较，差异无统计学意义(P>0.05)。采取回顾性分析法对RSV，FV及ADV感染导致的儿童重症CAP患儿的临床特征及治疗、转归情况进行比较分析(本研究遵循的程序符合广州市妇女儿童医疗中心人体试验委员会制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与其签署临床研究知情同意书)。

①同期RSV，FV和ADV感染导致的儿童重症CAP的发生率分别为7.64%(69/903)，4.96%(12/242)和3.53%(26/737)，其发生率比较，差异有统计学意义(χ²＝13.078，P＝0.001)。②3种病毒均可在无基础疾病的健康儿童中引发重症CAP，部分患儿在整个病程中无发热表现。3种病毒感染均可致急性期重症CAP患儿气管、支气管及分支支气管黏膜充血、水肿等炎症表现，其中以ADV感染的反应最为突出，甚至可导致"塑形性支气管炎"。③3组均采用抗菌药物＋抗病毒药物治疗；对合并喘息症状者采用氨茶碱、硫酸沙丁胺醇等治疗，必要时加用甲基强的松龙、静脉丙种球蛋白治疗；对合并呼吸衰竭者进行机械通气治疗，治疗全程重视气道护理。RSV组发生急性心力衰竭患儿占4.35%(3/69)，1例(1.45%)因急性呼吸窘迫综合征(ARDS)死亡；FV组2例(16.67%)出现休克，1例(8.33%)发生多脏器功能不全综合征，2例(16.67%)死于ARDS；ADV组无死亡病例。④3组部分患儿同时合并细菌、支原体、衣原体等感染。胸部X线检查结果发现，RSV，ADV组部分患儿右肺病变较左肺部明显，但FV组患儿双肺野炎症基本对称。

RSV，FV和ADV感染导致的儿童重症CAP患儿的临床特征既有共同点又有差异。儿童CAP感染导致的支气管内及分支支气管炎症反应突出，值得关注。对RSV，FV和ADV感染导致的儿童重症CAP，应采用综合治疗方案。

To explore clinical characteristics severe community-acquired pneumonia(CAP)infected with respiratory syncytial virus(RSV), influenza A virus (FV) and adenovirus (ADV) infected in children.

Clinical data of 107 cases of severe CAP of Guangzhou children's Medical Center were selected from January 1, 2005 to January 1, 2008. According to infection by different virus they were divided into group RSV (n=69, RSV infection), group FV (n=12, FV infection) and group ADV (n=26, ADV infection). Pneumonia and severe CAP were diagnosed by reference to"Management Guide of Community-Acquired Pneumonia of Children (trial)". No significant statistical difference in 3 groups among age, gender and hospitalization time (P>0.05). Clinical features, treatment and prognosis among 3 groups were retrospective compared and analyzed.

①The severe CAP incidence rates of RSV, FV and ADV were 7.64% (69/903), 4.96% (12/242) and 3.53% (26/737), respectively, and had significant difference among 3 groups(χ²=13.078, P=0.001). ②RSV, FV and ADV could cause severe CAP in healthy children without underlying disease, and some severe CAP cases had no fever syndrome in the whole course. Severe CAP cases in acute phase could have congestion, edema, inflammation in trachea, bronchus and branch of bronchial mucosa, in which ADV infected severe CAP cases was the most prominent and even could lead to"plastic bronchitis". ③All of the 3 groups cases were treated with antibiotics and virazole, those with wheezing symptoms were treated with aminophylline, salbutamol sulfate; when necessary, treated with methylprednisolone, intravenous immunoglobulin. combined with mechanical ventilation for those with respiratory failure, airway nursing were strengthened for entire course. RSV group of acute heart failure children accounted for 4.35% (3/69), 1 cases (1.45%)of death due to acute respiratory distress syndrome(ARDS); FV group had 2 cases (16.67%)of shock, 1 case (8.33%) had multiple organ dysfunction syndrome, 2 cases(16.67%)died of ARDS; ADV group had no dead case. ④There were co-infections with bacteria, mycoplasma, chlamydia for some severe CAP cases. The chest X-ray examination of some of RSV, ADV infected severe CAP cases had more obvious right lung lesions than that left lung, however, all of FV group cases had double lung inflammation basically symmetrical.

Clinical characteristics of severe CAP children infected with RSV, FV and ADV had common and difference, and ADV infected cases had more serious inflammation in bronchus and bronchus ramous. Integrated treatment had good functions to the severe CAP children.