Abstract: Objective　To investigate the clinical characteristics in children with adenovirus (ADV) combined with Mycoplasma pneumoniae (MP) infection, and to provide reference for clinical treatment. Methods　This was a case-control study. A total of 109 cases of ADV infected children admitted to Yuexiu District Children's Hospital of Guangzhou from May 2022 to May 2023 were classified as an ADV group, and 57 children with ADV combined with MP infection as an ADV+MP group. The general data (gender, age of onset, heat course, body mass index, etc.), clinical features [wheeze, shortness of breath, fever, rales, cough, pleural effusion, extrapulmonary complications, severe pneumonia, and Clinical Pulmonary Infection Score (CPIS)], imaging results, laboratory indicators [procalcitonin (PCT), white blood cell count (WBC), C-reactive protein (CRP), serum amyloid A (SAA), immunoglobulin (Ig) A, IgG, IgM, IgE, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH)], and clinical treatment (oxygen therapy, glucocorticoids, gammaglobulin use, length of hospital stay, hospital cost, rehospitalization rate for respiratory infection within 3 months) were compared between the two groups. Independent sample t test and χ2 test were used for statistical analysis. Results　There were 59 boys and 50 girls in the ADV group, 30 boys and 27 girls in the ADV+MP group, without statistically significant difference between the two groups (P>0.05). The age of onset in the ADV+MP group was lower than that in the ADV group [(4.32±1.25) years old vs. (5.24±1.01) years old], and the heat course was longer than that in the ADV group [(8.40±1.93) d vs. (5.54±2.12) d] (both P<0.05). The rates of rales, pleural effusion, and severe pneumonia and CPIS in the ADV+MP group were higher than those in the ADV group [68.42% (39/57) vs. 50.46% (55/109), 10.53% (6/57) vs. 2.75% (3/109), 29.82% (17/57) vs. 14.68% (16/109), (5.19±0.92) points vs. (4.33±1.27) points] (all P<0.05). The rates of lung consolidation and bilateral lung involvement in the ADV+MP group were higher than those in the ADV group [47.37% (27/57) vs. 29.36% (32/109), 63.16% (36/57) vs. 45.87% (50/109)] (both P<0.05). The WBC level in the ADV+MP group was lower than that in the ADV group [(11.63±3.95) ×109/L vs. (13.22±4.47) ×109/L], and the levels of CRP, SAA, IgM, and LDH were higher than those in the ADV group [(16.94±3.06) mg/L vs. (10.78±2.19) mg/L, (72.94±22.46) mg/L vs. (65.17±19.37) mg/L, (1.59±0.31) g/L vs. (1.22±0.43) g/L, (359.81±59.43) U/L vs. (313.44±51.32) U/L] (all P<0.05). The rates of oxygen therapy and gammaglobulin use, length of stay, hospitalization cost, and rehospitalization rate for respiratory infection within 3 months in the ADV+MP group were higher than those in the ADV group [40.35% (23/57) vs. 14.68% (16/109), 19.30% (11/57) vs. 1.83% (2/109), (8.67±1.52) d vs. (7.19±1.23) d, (4 518.59±1 241.85) yuan vs. (3 924.46±1 057.33) yuan, 14.04% (8/57) vs. 3.67% (4/109)] (all P<0.05). Conclusion　The inflammatory symptoms and clinical symptoms of ADV and MP infected children are more severe, the need for oxygen therapy and gammaglobulin is greater, and the risk of hospitalization is higher after recovery, suggesting that timely targeted treatment measures should be taken.

Key words:

Adenovirus, Mycoplasma pneumoniae, Clinical features, Children

摘要：

目的　探讨腺病毒（ADV）合并肺炎支原体（MP）感染患儿的临床特征，为临床治疗提供参考。方法　本研究为病例对照研究。选取2022年5月至2023年5月广州市越秀区儿童医院收治的109例ADV感染患儿为ADV组，57例ADV合并MP感染为ADV合并MP组。比较两组一般资料（性别、发病年龄、热程、体重指数等）、临床特征［喘息、气促、发热、啰音、咳嗽、胸腔积液、肺外并发症、重症肺炎情况以及临床肺部感染评分（CPIS）］、影像学结果、实验室指标［降钙素原（PCT）、白细胞计数（WBC）、C反应蛋白（CRP）、血清淀粉样蛋白A（SAA）、免疫球蛋白（Ig）A、IgG、IgM、IgE、谷丙转氨酶（ALT）、谷草转氨酶（AST）、乳酸脱氢酶（LDH）］和治疗情况（给予氧疗、糖皮质激素、使用丙种球蛋白、住院时间、住院费用、3个月内再次因呼吸道感染住院率）。采用独立样本t检验和χ²检验进行统计学分析。结果　ADV组男59例，女50例，ADV合并MP组男30例，女27例，两组比较差异无统计学意义（P>0.05）。ADV合并MP组发病年龄小于ADV组［（4.32±1.25）岁比（5.24±1.01）岁］，热程长于ADV组［（8.40±1.93）d比（5.54±2.12）d］（均P<0.05）。ADV合并MP组啰音、胸腔积液、重症肺炎比例和CPIS均高于ADV组［68.42%（39/57）比50.46%（55/109）、10.53%（6/57）比2.75%（3/109）、29.82%（17/57）比14.68%（16/109）、（5.19±0.92）分比（4.33±1.27）分］（均P<0.05）。ADV合并MP组肺实变和累及双侧肺部比例均高于ADV组［47.37%（27/57）比29.36%（32/109）、63.16%（36/57）比45.87%（50/109）］（均P<0.05）。ADV合并MP组WBC水平低于ADV组［（11.63±3.95）×10⁹/L比（13.22±4.47）×10⁹/L］，CRP、SAA、IgM和LDH水平均高于ADV组［（16.94±3.06）mg/L比（10.78±2.19）mg/L、（72.94±22.46）mg/L比（65.17±19.37）mg/L、（1.59±0.31）g/L比（1.22±0.43）g/L、（359.81±59.43）U/L比（313.44±51.32）U/L］（均P<0.05）。ADV合并MP组给予氧疗、使用丙种球蛋白比例及住院时间、住院费用、3个月内再次因呼吸道感染住院率均高于ADV组［40.35%（23/57）比14.68%（16/109）、19.30%（11/57）比1.83%（2/109）、（8.67±1.52）d比（7.19±1.23）d、（4 518.59±1 241.85）元比（3 924.46±1 057.33）元、14.04%（8/57）比3.67%（4/109）］（均P<0.05）。结论　ADV合并MP感染患儿炎症及临床症状更严重，患儿对氧疗及丙种球蛋白需求更大，病愈再感染住院风险更高，需及时采取针对性治疗措施。

关键词:

腺病毒, 肺炎支原体, 临床特征, 儿童