新生儿呼吸道合胞病毒肺炎309例临床及流行病学特点

Retrospective Analysis of Clinic and Epidemiology of Respiratory Syncytial Virus Pneumonia in 309 Neonates

目的探讨新生儿呼吸道合胞病毒(RSV)肺炎的临床及流行病学特点。方法2004年1月-2008年12月复旦大学附属儿科医院收治的诊断为RSV肺炎的309例新生儿(男196例,女113例),采用直接免疫荧光方法检测RSV抗原。收集所有病例的临床及流行病学资料,并根据感染方式、胎龄及病原学检测结果进行分组比较。结果5a共纳入309例新生儿RSV肺炎。男/女比为1.7:1.0。足月儿占87.1%。冬春季为好发季节。与社区获得性感染组比较,院内感染组早产儿比例高(23.2%vs8.7%,P=0.002),出生体质量低[(3010.8±852.8)gvs(3153.2±943.4)g,P=0.026],住院天数延长[(19.0±8.0)dvs(12.2±4.5)d,P=0],住院费用增加[(5646.4±3632.2)元vs(4175.8±2879.2)元,P=0],发病日龄晚[(21.3±8.6)dvs(15.8±6.0)d,P=0]。RSV并细菌或其他病毒感染组与单纯RSV感染组比较,住院费用高[(6063.1±3085.4)元vs(4513.2±3860.8)元,P=0.047],吸氧治疗比例高(40.0%vs25.7%,P=0.006)。新生儿RSV肺炎临床表现多样,早产儿组(与足月儿组比较)以呼吸暂停(20.0%vs0.7%)、发绀(42.9%vs22.7%)为主。42.0%并细菌感染,13.3%并其他部位感染,99.0%经治疗达到出院标准。结论RSV是新生儿肺炎的重要病原,冬春季好发。新生儿RSV肺炎临床表现不典型,院内感染患儿病情较重。本病尚缺乏有效预防治疗手段,预防感染和隔离是关键。

Objective To explore the characteristics of clinic and epidemiology of neonatal respiratory syncytial virus （RSV） pneumonia in newborn infants. Methods Three hundred and nine neonates （male 196,female 113） who were admitted to children＇s hospital of Fudan University and identified as having RSV pneumonia from Jan. 2004 to Dec. 2008 were enrolled. RSV antigen was detected in exfoliated respiratory cells by direct immunofluorescence. All the clinical data were collected and subjects and they were divided into different groups based on path of infection,gestational age and RSV status. Results From case notes over the 5 years,309 eligible neonates with RSV infection were identified. Male term neonates were more likely to acquire infection, as compared to female, 1.7 ： 1.0. The incidence of RSV infection peaked in winter and spring. Compared with community acquired infection group, hospital acquired infection group had more premature infants（23. 2% vs 8.7% ,P =0.002） ,lower birth weight[ （3 010.8 ±852.8） g vs （3 153.2 ±943.4） g,P =0. 026] ,much longer mean length of hospital stay [（19.0±8.0） dvs （12.2±4.5） d,P =0] ,more expensive cost[（5 646.4±3632.2） RMB vs （4 175.8±2 879.2） RMB,P=0] and later occurrence day [ （ 21.3 ± 8.6 ） d vs （ 15.8 ± 6.0 ） d, P = 01- Compared with simple RSV infection group, mixed infection group had more expensive cost [ （6 063.1± 3 085.4 ） RMB vs （4 513.2 ± 3 860.8 ） RMB,P = 0.047 ] and more oxygen use （40.0% vs 25.7 % , P = 0. 006）. The clinical characteristics of patients with RSV pneumonia varied. Preterm group compared with term group more frequently exhibited apnea and eyanosis（20.0% vs 0. 7% ,42.9% vs 22.7% ） ,respectively. Forty - two percent of them had bacterial infection,while 13.3% of them had infection of other part of body. The prognosis of most RSV （99.0%） infections was good. Conclusions RSV was an important cause of respiratory tract infections during the last five years. Clinical characteristics of RSV infections were atypical. Hospital acquired RSV infection was more severe than the community acquired infection in neonates. There are no specific, effective interventions for treating RSV infections,so preventive measures are most important.