不同年龄组麻疹住院患者临床特征比较

Comparisons of clinical and laboratory features among patients with measles in different age groups

目的探讨成人（≥18岁）麻疹和少年儿童（〈18岁）麻疹临床特征的差异，为正确诊断和早期预防提供参考资料。方法根据不同年龄组回顾性分析我院收治的239例麻疹住院患者资料。结果成人麻疹129例，男女之比为1：1．4；儿童麻疹110例，男女之比为2．9：1。成人组发热至出疹时间平均为（2．43±1．34）d，少年儿童组平均为（4．26±2．69）d，两组差异有统计学意义（t=6．48，P〈0．01）。成人组高热、呼吸道卡他症状、Koplik斑、结膜充血、腹泻及血小板减少的发生率分别为33％，65．1％，78．3％，84．5％，42．7％，17．8％，少年儿童组分别为14．5％，50．9％，56．4％，69．0％，22．9％，9．1％，均低于成人组（r值分别为11．27，4．94，4．90，8．06，10．57，5．03，P值均〈0．01或0．05）；成人组乳酸脱氢酶（LDH）、肌酸激酶、肌酸激酶同工酶、AST、ALT的升高率分别为63．6％，43．4％，38．0％，59．7％，48．1％，少年儿童组分别为42．7％，28．0％，20．0％，41．8％，30．9％，亦明显低于成人组（χ^2值分别为10．38，5．95，6．73，7．59，7．27，P值均〈0．01或0．05），其中LDH升高可能与并发症的发生有关（χ^2=12．60，P〈0．01）；成人组支气管肺炎发生率（16．3％）低于少年儿童组（31．8％），差异有统计学意义（χ^2=7．99，P〈0．01）。结论相对于少年儿童麻疹而言，成人麻疹临床症状重，预后相对较好，但临床易被忽视。

Objective To compare the clinical features between measles in adult and juvenile patients, and to provide references for correct diagnosis and early prevention of measles. Methods Clinical data were retrospectively collected from and analyzed for 239 inpatients with measles in the hospital. Results The ratio of males to females was 1 ： 1.4 and 2.9 ： 1 among adult patients （n = 129） and juvenile patients （n = 110）, respectively. The average duration from fever to eruption was shorter in adults than in juveniles （2.43±1.34） days vs （4.26 ± 2.69） days, （t = 6.48, P〈 0.01）. The incidence of hyperthermia, catarrhal symptoms, Koplik spots, conjunctival hyperemia, diarrhea and thrombocytopenia was 33.0%, 65.0%, 78.3%, 84.5%, 42.7% and 17.8%, respectively among adult patients, 14.5%, 50.9%, 56.4%, 69.0%, 22.9% and 9.0%, respectively among juveniles; the difference was significant between the two groups in all the above rates （P 〈 0.01 or 0.05）. Meanwhile, elevated activity of lactate dehydrogenase （LDH）, creatine kinase （CK）, MB isoenzyme of creatine kinase （CK-MB）, aspartate aminotransferase （AST）, alanine aminotransferase （ALT） was found in 63.6%, 43.4%, 38.0%, 59.7% and 48.1% of the adult inpatients, respectively, 42.7%, 28.0%, 20.0%, 41.8% and 30.9% of juvenile patients, respectively, with the difference being statistically signifi cant （χ^2 =10.38, 5.95, 6.73, 7.59, 7.27, P 〈 0.01, 0.05, 0.01, 0.01, 0.01, respectively）, Furthermore, the increase of LDH activity correlated with the occurrence of complications （χ^2 = 12.60, P 〈 0.01 ）. Bronchopneumonia was diagnosed in 16.3% of adult inpatients with measles and 31.8% of juvenile inpatients （t = 7.99, P 〈 0.01 ）. Conclusions Measles in adults tends to have a more severe clinical symptom but a better prognosis compared with measles in juveniles; however, this is often ignored in clinical practice.