影响毛细支气管炎患儿临床严重程度的因素

Factors for Affecting Severity of Bronchiolitis in Children

目的探讨影响毛细支气管炎患儿临床严重程度的相关因素。方法统计分析904例毛细支气管炎住院患儿的年龄、性别、出生体质量、发病季节、肥胖情况、病情轻重、临床表现、病原及过敏原检测、胸部X线检查、哮喘家族史、湿疹史、喂养方式、先天性心脏病、农村居住环境和住院天数等资料。按病情严重程度将住院的毛细支气管炎患儿分为轻型和重型二组,进行组间单因素比较,采用BinaryLogistic回归分析方法对影响毛细支气管炎病情的各项因素进行相关性分析。结果1.住院的毛细支气管炎患儿中,肥胖者占56%(506/904例)。2.住院患儿904例病原检出率为78.3%,其中呼吸道合胞病毒(RSV)占43.5%,人类巨细胞病毒(CMV)占47.6%,柯萨奇病毒(CBV)占7.9%,肺炎支原体(MP)占1.8%,腺病毒(ADV)占1.7%,EB病毒(EBV)占0.15%。3.轻、重型毛细支气管炎二组患病年龄、病原构成、出生体质量、农村居住环境、住院天数、伴先天性心脏病等因素比较有统计学差异(χ2=3.47,19.62,2.32,2.61,-4.71,69.23P=0.001,0.006,0.02,0,0,0)。重型毛细支气管炎与患病年龄、出生体质量、伴先天性心脏病、农村居住环境和住院天数的优势比有统计学意义(OR=0.840,0.542,15.412,5.305,1.173P=0.0133,0.0497,0.0003,0,0.0002)。结论1.毛细支气管炎患儿多有肥胖;2.除RSV外,CMV、CBV、ADV、MP和EBV均可引起毛细支气管炎。3.小月龄、低出生体质量、先天性心脏病和农村居住是发生重型毛细支气管炎的危险因素;住院时间可用于衡量毛细支气管炎的严重程度。

Objective To explore the factors affecting severity of infants with bronchiolitis in hospital. Methods Data were collected from hospitalized case of bronchiolitis including age, gender, birth weight, incidence season, overweight, severity of bronchiolitis, clinical mani- festation, pathogen, total and specific immunoglobulin - E （ IgE）, X - ray appearance, family asthma history, eczema, feeding patterns, congenital heart disease, countryside dwelling and length of stay. All cases were divided according severity extent into 2 groups. Then one - factor ana- lytical method was used between 2 groups, and risk factors for these outcomes were identified by Logistic regression analysis. Results 1. Nearly 56% （506 of 904） of children were considered as obesity. 2. The positive rate of the virus infection identified from 904 infants with bronc hiolitis was 78.3 %. Of them, the respiratory syncytial virus （RSV） infection accounted for 43.5 %, cytomegalovirus （CMV） for 47.6% , coxsackie b virus （CBV） for 7.9% , Mycoplasma pneumonia （MP） for 1.8%, adenovirus （ADV） for 1.7 % and epstein - barr virus （EBV） for 0.15% , respectively. 3. There were notable differences between mild group and severe group in age, pathogen, birth weight, countryside dwel- ling,congenital heart disease and hospital day（x2 =3.47,19.62,2.32,2.61, -4.71,69.23 P =0.001,0.006,0.02,0,0,0）. There was a significant association between severe bronehiolitis and young age,low birth weight, congenital heart disease, countryside dwelling and hospital days （OR=0.840,0.542,15.412,5.305 and 1. 173,respectively P=0.013 3,0.049 7,0.000 3,0,0.000 2）, Conclusions 1. Obesity may have great risk for bronchiolitis. 2. Except for RSV, CMV, CBV, ADV, MP and EBV all were pathogens associated with childhood bronehiolitis. 3. The factors that contribute to increase risk of severe bronehiolitis are young age,low birth weight, congenital heart disease and countryside dwelling. And length of stay may estimate severity of infants with bronchiolitis in hospital.