中国1O省（市）2009-2014年15岁以下儿童流感确诊住院病例严重急性呼吸道感染临床特征及其危险因素分析

Clinical characteristics of hospitalized cases of severe acute respiratory infection with laboratory-confirmed influenza and the risk factors analysis of influenza infection for children under 15 years old in ten provinces in China during 2009-2014

目的 探讨我国〈15岁儿童流感确诊病例严重急性呼吸道感染（SARI）临床特征及感染危险因素。方法 分析10省市2009年12月至2014年6月SARI哨点监测系统纳入的〈15岁儿童流感实验室确诊住院病例。通过调查表收集病例人口学、既往疾病史、临床症状和体征、治疗和结局等信息,描述临床特征及流感感染危险因素。结果 纳入的2 937例儿童SARI住院病例中,190例（6.5%）为流感确诊病例。流感确诊病例中,男性123例（64.7%）,〈5岁儿童139例（73.2%）,年龄M=3.0（IQR：1.0～5.0）岁。20例（10.5%）至少有一种慢性基础性疾病,其中慢性心血管疾病（3.2%）、免疫抑制性疾病（3.2%）和肿瘤（2.6%）最常见。发热（92.6%）和咳嗽（88.8%）是最常见的临床症状,肺部听诊异常（51.1%）和X线表现肺部异常（36.1%）是最常见的临床体征。29例（15.8%）出现并发症,以肺炎（15.3%）为最常见的并发症。16例（8.6%）服用抗病毒药物,4例（2.2%）收入ICU治疗。危险因素分析提示,〈6月龄是流感病毒感染的保护因素（OR=0.406,95%CI：0.203～0.815）,5～9岁是流感病毒感染的危险因素（OR=2.535,95%CI：1.059～6.066）。结论 流感确诊病例主要集中在〈5岁儿童,不同年龄组病例感染流感病毒的风险存在差异。

Objective To identify clinical characteristics of hospitalized laboratory-confirmed influenza cases of children under 15 years old,and their risk factors of influenza infection. Methods Analyzing the reports of hospitalized laboratory-confirmed influenza cases of children under 15 years old who were detected by the sentinel surveillance systems in 10 provinces from December 2009 to June 2014. Such data as their demographic,medical history,clinical symptoms and signs,treatment and outcome were collected using questionnaires,with their clinical characteristics and their risk factors of influenza infection described. Results Of the 2 937 severe acute respiratory infection inpatients,190 （6.5%） were laboratory-confirmed influenza cases. 123 （64.7%） of such confirmed cases were male,and 139 （73.2%） were children under 5 years old, with age median of 3.0 years （IQR：1.0-5.0 years）. 20 （10.5%） of them had at least one chronic medical condition,mostly chronic cardiovascular disease （3.2%）,immunosuppressive disease （3.2%）,and cancer/tumor （2.6%）. Most common clinical symptoms of the cases were fever （92.6%） and cough （88.8%）,of which abnormal pulmonary auscultation （51.1%） and abnormal chest X-ray performance （36.1%） were the most common clinical signs. 29 cases （15.8%） had complications,of which pneumonia （15.3%） was most common. 16 cases （8.6%） used antiviral drugs,and 4 cases （2.2%） were admitted into ICU. Risk factor analysis suggested that age 〈6 months （OR=0.406,95%CI：0.203-0.815） was a protective factor against influenza infection;and age 5-9 years old （OR=2.535,95%CI：1.059-6.066） was a risk factor for influenza infection. Conclusion Hospitalized laboratory- confirmed influenza cases were found mostly in children under 5 years old. Risk exposure for influenza infection varied among age groups.