腺病毒相关肝损伤患儿的临床特征及其影响因素

摘要/Abstract

摘要： 目的了解腺病毒相关肝损伤患儿的临床特征及其影响因素。方法 2019年4月至2023年4月宁南县人民医院收治的腺病毒感染患儿572例,其中肝损伤组236例,非肝损伤组336例。比较两组患儿的临床资料,多因素logistic回归分析腺病毒相关肝损伤患儿的危险因素。结果肝损伤组患儿男性、重症肺炎、胃肠炎、喘息、气促、呼吸困难、心力衰竭、混合感染比例分别为64.0%、19.1%、8.1%、37.3%、27.5%、20.3%、10.6%、53.0%,高于非肝损伤组的55.1%、12.5%、3.9%、25.6%、18.8%、12.8%、6.0%、42.3%;肝损伤组年龄、C反应蛋白(CRP)、降钙素原(PCT)、IL-6、ALT、AST、TBil、γ-谷氨酰转肽酶(GGT)、乳酸脱氢酶(LDH)和住院时间分别为(2.8±1.0)岁、(28.6±4.4)mg/L、(1.7±0.4)ng/mL、(78.4±20.8)pg/mL、(75.7±25.2)U/L、(162.3±45.6)U/L、(5.6±2.1)μmol/L、(18.1±10.3)U/L、(645.2±501.2)U/L和(10.5±2.3)d,高于非肝损伤组的(3.1±1.1)岁、(25.3±3.8)mg/L、(1.2±0.2)ng/mL、(36.5±16.3)pg/mL、(46.8±12.5)U/L、(124.6±40.3)U/L、(4.9±2.3)μmol/L、(12.4±8.6)U/L、(354.6±98.7)U/L和(8.1±1.6)d;肝损伤组支气管炎比例、Hb、IL-10分别为29.7%、(114.8±12.1)g/L、(1.08±0.4)pg/mL,低于非肝损伤组的30.1%、(119.4±10.5)g/L、(2.3±0.5)pg/mL,差异均有统计学意义(P<0.05)。重症肺炎[OR(95%CI):2.563(1.112~5.906)]、GGT[OR (95%CI):1.982(1.054~3.725) ]、LDH[OR (95%CI):2.100(1.056~4.179) ]是患儿发生肝损伤的独立危险因素。结论腺病毒相关肝损伤以年龄低的男性患儿常见,重症肺炎患儿肝损伤发生率高,临床症状以发热为主,重症肺炎、GGT、LDH是腺病毒相关肝损伤的影响因素。

关键词: 腺病毒, 肝损伤, 临床特征, 影响因素, 儿童

Abstract: Objective To elucidate the clinical characteristics and identify determinants impacting the course of adenovirus-associated liver injury among a cohort of 236 pediatric patients. Methods Between April 2019 and April 2023, 572 pediatric patients with adenovirus infection were admitted to our hospital and stratified into two cohorts based on liver function: 236 in the liver injury group and 336 in the non-liver injury group. Comprehensive analysis of clinical data was conducted, employing multi-factorial logistic regression to identify risk factors associated with adenovirus-induced liver injury in children. Results In our cohort, pediatric patients with adenovirus-associated liver injury(n=236) demonstrated significantly higher rates of male gender(64.0%), severe pneumonia(19.1%), gastroenteritis(8.1%), wheezing(37.3%), respiratory distress(27.5% for shortness of breath and 20.3% for dyspnea), heart failure(10.6%), and mixed infections(53.0%) compared to those without, liver injury(P<0.05). Additionally, clinical and laboratory parameters including age, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBiL), gamma-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), and length of hospital stay were significantly elevated in the liver injury group compared to their counterparts, indicating a more severe clinical profile(P<0.05). Conversely, bronchiolitis prevalence, hemoglobin levels, and interleukin-10 (IL-10) were lower in patients with liver injury, underscoring the complexity of adenovirus impact on pediatric health. Multivariable logistic regression identified severe pneumonia, elevated GGT, and LDH levels as independent predictors of liver injury, highlighting their potential as diagnostic markers(P<0.05). Conclusion Adenovirus-associated liver injury predominantly affects male pediatric patients of younger age, with a notably high incidence observed among those presenting with severe pneumonia. The clinical presentation is primarily characterized by fever and severe pneumonia. Furthermore, GGT and LDH levels emerge as significant biochemical markers, influencing the risk and severity of adenovirus-associated liver injury. This underscores the importance of recognizing specific clinical and laboratory parameters for the early identification and management of this condition in the affected pediatric population.

Key words: Adenovirus, Liver injury, Clinical features, Influencing factors, Children

秦攸余, 邓巧妮. 腺病毒相关肝损伤患儿的临床特征及其影响因素[J]. 肝脏, 2024, 29(5): 576-580.

QIN You-yu, DENG Qiao-ni. Adenovirus-associated liver injury in children: Clinical characteristics and influencing factors in a cohort of 236 cases[J]. Chinese Hepatolgy, 2024, 29(5): 576-580.

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