1999年-2008年上海儿科医院住院流感患儿的流行病学和临床特征

Clinical and epidemiological characteristics of influenza-associated respiratory infection in children hospitalized in Shanghai Children＇s Hospital during 1999-2008

目的 了解住院儿童流感病毒感染的流行病学和临床特征.方法 回顾性分析1999年-2008年期间复旦大学附属儿科医院253例流感病毒检测阳性的急性呼吸道感染住院儿童的流行病学和临床特征.实验室确诊流感病毒感染是通过直接免疫荧光法检测鼻咽吸取物中甲型和乙型流感病毒抗原.各组间年龄中位数、住院天数的比较采用秩和检验,各组间发热和咳嗽症状的比较采用卡方检验.结果 253例流感病毒检测阳性的住院儿童中,男182例,女71例,年龄最小5 d,最大10岁7个月,年龄中位数18个月.〈6个月53例,≥6个月～〈2岁95例,≥2岁～〈5岁85例,≥5岁20例.肺炎190例,支气管炎49例,上呼吸道感染14例,其中11例合并高热惊厥,6例合并支气管哮喘急性发作,3例合并病毒性脑炎.29例有基础疾病.最常见的症状为咳嗽238例和发热209例,140例为高热,平均发热天数为（5.0士2.9）d.6个月以上儿童发热和咳嗽症状较6个月以下婴儿更常见（X2=22.895、16.992,均P〈0.01）.高热惊厥都发生于2岁以上儿童.251例行外周血常规检查发现,39例wBC减少.结论 5岁以下婴幼儿和托幼儿童是流感的高危人群,应重视对6个月～5岁健康儿童以及易患流感的高危儿童的流感疫苗接种.

Objective To study the clinical and the epidemiological features of hospitalized children with influenza virus infection. Methods Two hundred and fifty-three inpatients with laboratory-confirmed influenza virus infection from 1999 to 2008 were reviewed for analyzing the clinical and epidemiological characteristics. Type A and B influenza viruses in the nasopharyngeal aspirates were detected by immunofluorescence assay. Mann-Whitney U test were performed for comparing the median age and the length of hospitalization. Chi-square test was performed for comparing the proportion of patients with fever and cough. Results Among 253 hospitalized children aged between 5 days and 127 months, 182 （71.9%） were boys and 71 （28. 1%） were girls. The median age was 18 months. Fifty-three cases were infants younger than 6 months. 95 cases were children aged between 6 months and 2 years, 85 cases were aged between 2 years and 5 years and 20 cases were older than 5 years. The diagnosis of influenza-related admission included pneumonia （190 cases）, bronchitis （49 cases） and upper respiratory tract infection （14 cases）. Eleven cases developed febrile convulsion, 6 cases had acute exacerbation of asthma and 3 cases had concomitant viralencephalitis. Twenty-nine cases had basic diseases. Cough and fever were the most common symptoms. Two hundred and thirty-eight cases presenting cough and 209 case presenting fever. Sixty-seven percent （140/209） had high fever with body temperature higher than 39 ℃. The average duration of fever was （5. 0 ±2. 9） days. Fever and cough were both more common in children older than6 months （X2 = 22. 895,P〈0. 01; X2 = 16. 992,P〈0. 01, respectively）. Febrile convulsion occurred in children older than 2 years. Fifteen point five （39/251） developed leukocytopenia. Conclusions Children younger than 5 years old are at high risk of influenza-related hospitalization. We should emphasize influenza vaccination in previously healthy children aged between 6 months and 5 years and children with underlying diseases.