新生儿和婴儿呼吸道合胞病毒致急性下呼吸道感染临床特征和疾病负担

Clinical features and disease burden of acute low respiratory infection caused by respiratory syncytial virus in hospitalized neonates and infants

目的了解上海地区新生儿和婴儿呼吸道合胞病毒(RSV)感染的严重程度及疾病负担,为RSV感染的监测及临床防治提供科学依据。方法回顾性收集2012年3月至2013年2月复旦大学附属儿科医院内科和新生儿科住院并确诊为急性下呼吸道感染(ALRI)≤1岁患儿的病历,截取人口学资料、临床特征、病死率、并发症、住院时间和费用等指标,并采用严重度指数(SI)进行RSV感染严重程度综合评价。分为新生儿组和婴儿组,并进一步分为单一感染和混合感染亚组进行分析。结果 1 726例ALRI≤1岁患儿中RSV阳性913例(52.9%)进入分析。新生儿组295例,婴儿组618例。①SI评分新生儿组高于婴儿组,(2.5±0.2)vs(1.9±0.1)分,P<0.05;较重度和重度比例新生儿组显著高于婴儿组,但单一感染和混合感染亚组间差异无统计学意义。②RSV感染的≤1岁患儿病死率为5.0%,新生儿组病死率与婴儿组差异无统计学意义,婴儿组合并基础疾病患儿病死率高。③机械通气比例两组间差异无统计学意义,婴儿组混合感染亚组高于单一感染亚组。④并发症情况:新生儿组呼吸暂停和脓毒症发生率较高,新生儿组混合感染亚组脓毒症发生率显著高于单一感染亚组。⑤住院天数新生儿组与婴儿组差异无统计学意义,合并基础疾病者显著高于未合并疾病疾病患儿;住院费用婴儿组显著高于新生儿组,新生儿混合感染亚组显著高于单一感染亚组,合并基础疾病患儿显著高于未合并基础疾病患儿。结论 RSV感染新生儿的重症比例和并发症的发生率较高,婴儿组住院费用较高。混合感染和合并基础疾病是影响RSV感染严重程度和疾病负担的重要因素。

Objective To investigate the severity and disease burden of respiratory syncytial virus( RSV) infection in hospitalized infants with acute low respiratory tract infection( ALRI). Methods ALRI infants,who were admitted to Children's Hospital of Fudan University from March 1st,2011 to February 29th,2012,were enrolled in this study. Patient information included demographic characteristics,death,complication,length of stay and cost in hospital. The severity of RSV infection was evaluated by severity index( SI). Results In total,1 726 ALRI infants included 571 neonates and 1 155 infants. Of all patients,there were 913 infants with RSV infection( 52. 9% I). ①SI evaluation: Neonates had higher SI than infants( 2. 5 ± 0. 2 vs 1. 9 ± 0. 1,P < 0. 05). The percentage of moderate-severe patients was significantly higher in neonates than that in infants,but no significant difference was found between mono-infection and co-infection subgroups. ②The mortality of RSV infection was 5. 0%. There was no difference in mortality between neonates and infants. Infants with underlying diseases had higher mortality. ③No difference was found in rates of mechanical ventilation between two groups. The infants with co-infection had higher rates than those with mono-infection. ④ Complications: neonates had higher incidence of apnea and sepsis than infants,neonates with co-infection had higher incidence of sepsis. ⑤No difference was found in hospital stay between infants and neonates,but longer hospital stay was found in those without underlying diseases. Infants had higher hospital cost than neonates. And higher hospital cost was found in the patients with coinfection compared to those with mono-infection,and also in those with vs without underlying diseases. Conclusion Neonates with RSV infection have higher mortality and incidence of complications,and infants have higher cost of stay in hospital. Co-infection and underlying diseases are the important factors affecting the severity of RSV infection.