【摘要】 背景人偏肺病毒（HMPV）是儿童呼吸道感染的重要病原体之一，可导致重症肺炎等炎症疾病。目的 分析儿童HMPV肺炎的临床特征及重症肺炎发生的危险因素。设计回顾性病例对照研究。方法 回顾性纳入2023年4月至2024年12月天津市儿童医院马场院区呼吸科及感染科住院的158例HMPV肺炎病例，根据社区获得性肺炎（CAP）诊断标准分为重症组和轻症组，收集患儿人口学信息、临床特征、实验室检查、治疗等情况，分析两组间临床表现差异及重症肺炎发生的危险因素。主要结局指标儿童HMPV肺炎临床特征和重症肺炎相关危险因素。结果 158例患儿年龄中位数3（1,5）岁，5岁以下儿童占86.7%。男性94例（59.5%），女性64例（40.5%）。每年3、4、5月份发病人数最多。儿童HMPV肺炎主要表现为发热（146例，92.4%）、咳嗽（158例，100%）及喘息（48例，30.4%）。重症肺炎52例（32.9%），轻症肺炎106例（67.1%）。重症肺炎组较轻症肺炎组年龄大[4（2,5）岁vs. 3（2,5）岁]，住院时间、发热时间更长[8（6,9）d vs. 6（5,7）d、4（3,5）d vs. 2.5（1,4）d]，热峰高[39.8（39.0,40.0）℃vs. 39.0（38.5,39.5）℃]、心率快[120（108,135）次·min^-1 vs. 111（100,120）次·min^-1]、血氧饱和度低[0.94（0.92,0.98） vs. 0.98（0.97,0.99）]、儿童早期预警评分高[0（0,1） vs. 0（0,0）]，差异均有统计学意义（P<0.05）。重症肺炎较轻症肺炎组淋巴细胞数减低，中性粒细胞数、中性粒细胞/淋巴细胞比值、C反应蛋白、降钙素原、血沉、白介素?6增高，差异均有统计学意义（P<0.05）。HMPV肺炎中混合感染共64例（40.5%），重症肺炎组33例，轻症肺炎组31例。134例（84.8%）患儿胸部影像学显示为单侧或双侧肺散在小片炎性实变，共24例（15.2%）患儿肺CT提示有大片肺实变，其中5例有肺不张。45例（28.5%）患儿给予全身糖皮质激素治疗，重症肺炎27例，轻症肺炎18例；6例（3.8%）患儿给予人免疫球蛋白治疗，重症肺炎5例，轻症肺炎1例；共19例（12.0%）进行气管镜灌洗治疗，重症肺炎16例，轻症肺炎3例。混合感染、肺大片炎症、肺不张、糖皮质激素、人免疫球蛋白、气管镜治疗在两组间差异均有统计学意义（P<0.05）。所有患儿均好转出院。Logistic回归分析发现热峰升高（OR=3.189, 95% CI:1.355～7.505）、血氧饱和度降低（OR=0.406, 95% CI:0.260～0.632）、肺大片实变（OR=0.093, 95% CI:0.019～0.458）和混合感染（OR=0.213, 95% CI:0.059～0.766）是发生重症HMPV肺炎的危险因素。结论 儿童HMPV肺炎主要临床表现为咳嗽、发热及喘息，重症肺炎比例高，易合并其他病原感染，胸部影像学大部分表现为单侧或双侧肺散在小片炎性实变，重症肺炎肺大片实变比例高。热峰升高、血氧饱和度降低、肺大片实变、混合感染是发生重症HMPV肺炎的危险因素。更多还原

【Abstract】 Background Human Metapneumovirus(HMPV) is a significant pathogen causing respiratory infections in chil?dren and can lead to severe inflammatory diseases such as severe pneumonia. Objective To analyze the clinical characteristics of pediatric HMPV pneumonia and identify risk factors associated with severe pneumonia. Design Retrospective case ? control study. Methods The study retrospectively enrolled 158children diagnosed with HMPV pneumonia and hospitalized in the Respira?tory Department and Infectious Disease Department of Tianjin Children’s Hospital(Machang Campus) from April 2023 to Decem?ber 2024. Based on diagnostic criteria for community?acquired pneumonia, patients were classified into severe and mild groups. De?mographic data, clinical features, laboratory findings, and treatment regimens were collected to analyze differences in clinical manifestations between the two groups and identify risk factors for severe pneumonia. Main outcome measures Clinical charac?teristics of pediatric HMPV pneumonia and risk factors associated with severe pneumonia. Results Among the 158 children, the median age was 3 years(IQR 1?5), with 86.7% under 5 years old. Males accounted for 59.5%(94 cases) and females 40.5%(64 cases). Incidence peaked annually in March, April and May. Clinical manifestations included fever(146 cases, 92.4%), cough(158 cases, 100%), and wheezing(48 cases, 30.4%). Severe pneumonia was observed in 52 cases(32.9%) and mild pneumonia in 106 cases(67.1%). The severe group, compared to the mild group, had older age [4(IQR 2?5) vs. 3(IQR 2?5) years], longer hospitalization and fever duration [8(IQR 6?9) vs. 6(IQR 5?7) days; 4(IQR 3?5) vs. 2.5(IQR 1?4) days], higher peak fever [39.8℃(IQR 39.0?40.0) vs. 39.0℃(IQR 38.5?39.5)], faster heart rate [120(IQR 108?135) vs. 111(IQR 100?120)],lower oxy?gen saturation [0.94(IQR 0.92?0.98) vs. 0.98(IQR 0.97?0.99)], and higher Pediatric Early Warning Scores [0(IQR 0?1) vs. 0(IQR 0?0)](P < 0.05). The severe group also exhibited reduced lymphocyte counts and elevated neutrophil counts, neutrophil?to?lymphocyte ratio, C ? reactive protein, procalcitonin, and interleukin ? 6 levels(P < 0.05). Co ? infections occurred in 64 cases(40.5%): 33 in the severe group and 31 in the mild group. Chest imaging revealed unilateral or bilateral patchy consolidations in 134 cases(84.8%), while 24 cases(15.2%) showed large consolidations on CT, including 5 with atelectasis. Treatments included systemic corticosteroids(45 cases, 28.5%), human immunoglobulin(6 cases, 3.8%), and bronchoscopic lavage(19 cases, 12.0%). Significant differences(P < 0.05) were observed between the severe and mild groups in co?infection rates, large consolida?tions, atelectasis, and use of corticosteroids, immunoglobulin, and bronchoscopy. All patients recovered and were discharged. Lo?gistic regression analysis identified elevated peak fever(OR = 3.189, 95% CI: 1.355?7.505), reduced oxygen saturation(OR = 0.406, 95% CI: 0.260?0.632), large pulmonary consolidations(OR = 0.093, 95% CI: 0.019?0.458), and co?infection(OR = 0.213, 95% CI: 0.059?0.766) as independent risk factors for severe HMPV pneumonia. Conclusion Pediatric HMPV pneumo?nia primarily manifests with cough, fever, and wheezing. Severe pneumonia cases are prevalent and often co?occur with other patho?gens. Chest imaging predominantly shows unilateral or bilateral patchy inflammatory consolidations, while severe cases exhibit a higher proportion of large consolidations. Elevated peak fever, hypoxemia, large pulmonary consolidations, and co?infection are significant risk factors for severe HMPV pneumonia.更多还原