目的探讨7型腺病毒肺炎患者的临床表现及7型腺病毒株（CHN/BeiJing/2018）的基因组学特征。
方法收集2017年10月27日至2018年2月28日北京某兵营群发性7型腺病毒肺炎病例42例，均为男性，年龄20~25岁，平均（21±2）岁。收集BALF并用试剂盒提取其中的腺病毒DNA，进行病毒全基因组测序，将所得序列与国内外已知流行株进行在线比对。应用Mega 6.0软件基于A~F腺病毒不同亚属全基因组绘制系统进化树并进行相关分析。
结果42例中38例表现为流感样症状，36例发热，41例咳嗽，38例咳痰，12例出现胸痛，5例合并化脓性扁桃体炎。4例出现一过性痰中带血，3例出现喘息，肺部体检无明显阳性体征，仅3例肺部可闻及湿性啰音；8例患者肌酸激酶明显升高（肌酸激酶>400 U/L），经治疗后均恢复正常。4例合并低氧血症，动脉血氧分压<80 mmHg（1mmHg=0.133 kPa），未出现呼吸衰竭和急性呼吸窘迫综合征病例。胸部影像学可见斑片状渗出或实变影，双肺各叶段均可受累，以肺下叶多见。10例合并流感病毒感染，32例合并非典型病原体感染。本次分离株基因组与国内外已知流行株（19BOVLB/Volg ograd/Rus/2014及0901HZ/ShX/CHN/2009）基因组覆盖率为100%，同源性为99%，基因片段无明显插入或缺失，未见关键位点碱基突变；进化分析提示该病毒株与2012年湖北荆门分离的7型腺病毒株亲缘关系最近。
结论7型腺病毒肺炎临床主要表现为轻型肺炎，呈自限性，对症治疗后多数患者预后良好。引起本次腺病毒肺炎的7型腺病毒流行株与其他国内外流行株基因组相比无明显突变，提示7型腺病毒可以在外界环境中长期存在，导致散发病例或在小范围内流行。
ObjectiveTo better understand the clinical features of human adenovirus type 7 (hAdV7) pneumonia and to identify whether there is a variation in the genome of the strain (CHN/BeiJing/2018) isolated during the small-scale epidemic.
MethodForty-two patients were diagnosed with hAdV7 pneumonia between October 27th, 2017 and February 28th, 2018. They were all males with an average age of (21±2) years. Demographic and clinical data were reviewed and analyzed in detail. The nucleic acid of the epidemic strain was extracted from a bronchoalveolar lavage fluid sample. Whole genome sequencing (WGS) was then performed and sequences were compared with other hAdV7 strains distributed globally. Phylogenetic tree analysis was conducted based on whole genome sequences of the epidemic strain.
ResultsThirty-eight cases with hAdV7 pneumonia presented with influenza-like symptoms (90.5%) at the onset and 36 cases developed fever (85.7%), followed by cough (97.6%), expectoration (90.5%) and chest pain (28.6%). Five cases presented with tonsillitis(11.9%) and 4 had transient hemoptysis (9.5%), while 3 patients reported dyspnea (7.1%). Moist rales were only heard in 3 patients (7.1%). Notably elevated creatine kinase (CK) concentrations were observed in 8 patients (19.1%), but all returned to normal after treatment. Four cases developed hypoxemia (9.5%), but none of them progressed to respiratory failure or acute respiratory distress syndrome (ARDS). Chest CT imaging showed bilateral patchy parenchymal opacities with a random distribution with or without consolidation. Ten patients were co-infected with influenza virus (23.8%), while 32 patients developed atypical pneumonia (76.2%). Genomic analysis revealed that the strain isolated during this epidemic was 99% similar to the known hAdV7 strains (19BOVLB/Volgograd/Rus/2014 and 0901HZ/ShX/CHN/2009). Phylogenetic tree analysis suggested that the strain was closely related to the hAdV7 strain isolated in Jingmen China in 2012.
ConclusionsCases with hAdV7 pneumonia were generally mild. Symptomatic treatment was sufficient for a favorable prognosis. A good genome stability of the hAdV7 strain was observed, indicating that hAdV7 could remain stable for a long period and cause continuing sporadic cases and clusters.
Li Xiaofang, Xi Wen and Wang Yuanyuan are contributed equally to the article
李小芳,席雯,王媛媛,等. 群发7型腺病毒肺炎42例临床特点及基因组学分析[J]. 中华结核和呼吸杂志,2019,42(3)：206-212.
DOI:10.3760/cma.j.issn.1001-0939.2019.03.011版权归中华医学会所有。
未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。
除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
李小芳、席雯和王媛媛对本文有同等贡献
文档即答
智问智答
机器翻译
你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。
