阜阳地区儿童腺病毒感染的临床特征 及重症肺炎危险因素分析

Clinical Characteristics and Risk Factors for Severe Pneumonia in Children with Adenovirus Infection in Fuyang Area

摘要: 目的：探讨阜阳地区儿童腺病毒感染的临床特征，分析重症腺病毒肺炎的危险因素，为临床早期识别与诊治提供依据。方法：回顾性分析2024年1月至12月安徽医科大学附属阜阳人民医院收治的599例腺病毒感染住院患儿的临床资料。总结其流行病学及临床特征；将腺病毒肺炎患儿分为轻症组(n = 217)与重症组(n = 95)，采用单因素及多因素Logistic回归分析重症肺炎的独立危险因素。结果：599例患儿中，男女比例1.5:1，0至3岁婴幼儿占48.1%。发病集中于春夏季(4~7月)，5月为峰值。腺病毒3型是绝对优势流行株(82.8%)。临床表现以发热(87.5%)、咳嗽(80.3%)为主。与轻症组相比，重症组患儿发热时间更长，咳痰及肺部湿啰音更常见，CRP、AST、LDH、IgG水平显著升高，IgA水平降低(均P < 0.05)。多因素Logistic回归分析显示，年龄 ≤ 3岁(OR = 1.642)、合并肺炎支原体感染(OR = 4.215)、合并细菌感染(OR = 2.713)、CRP升高(OR = 1.011)、LDH升高(OR = 1.004)是重症肺炎的独立危险因素，而IgA (OR = 0.820)是保护因素。结论：阜阳地区儿童腺病毒感染以婴幼儿为主，HAdV3型为主要流行株。年龄 ≤ 3岁、合并肺炎支原体或细菌感染、CRP及LDH升高是重症肺炎的高危因素，而较高的IgA水平可能降低重症风险。

Abstract: Objective: To characterize the clinical features of adenovirus infection in children and identify risk factors for severe adenovirus pneumonia in Fuyang area. Methods: A retrospective study was conducted on 599 hospitalized children with confirmed adenovirus infection from January to December 2024. Epidemiological and clinical data were collected. Children with adenovirus pneumonia were divided into mild (n = 217) and severe (n = 95) groups. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for severe pneumonia. Results: Among 599 children, the male-to-female ratio was 1.5:1, and infants aged 0~3 years accounted for 48.1%. The incidence peaked in spring and summer (April-July), with the highest number in May. Human adenovirus type 3 was the dominant serotype (82.8%). Common symptoms were fever (87.5%) and cough (80.3%). Compared to the mild group, the severe group had longer fever duration, higher incidence of expectoration and moist rales, significantly elevated levels of CRP, AST, LDH, IgG, and lower IgA levels (all P < 0.05). Multivariate analysis identified age ≤ 3 years (OR = 1.642), coinfection with Mycoplasma pneumoniae (OR = 4.215), bacterial coinfection (OR = 2.713), elevated CRP (OR = 1.011), and elevated LDH (OR = 1.004) as independent risk factors for severe pneumonia, while IgA (OR = 0.820) was a protective factor. Conclusions: Adenovirus infection in Fuyang area predominantly affects young children, with HAdV3 being the main serotype. Age ≤ 3 years, coinfection with M. pneumoniae or bacteria, elevated CRP and LDH are significant risk factors for severe pneumonia, while higher IgA levels may be protective.