西安地区儿童百日咳857例临床特征分析

Analysis of clinical characteristics in 857 patients with pediatric pertussis in Xi＇an

目的分析百日咳患儿的临床特征，为诊治百日咳提供参考。方法回顾西安地区2015年1月至2016年12月百日咳患儿病历资料，收集人口学资料、症状、体征、辅助检查及治疗转归等信息，应用描述性方法进行流行病学特征分析。结果857例百日咳患儿来自城区183例（21.3%），农村674例（78.7%）；男女比例为1.211.00；全年各月均有病例，7－9月和2－4月较多，分别占41.5%（355/857例）和25.4%（218/857例）；〈6月龄患儿473例（55.2%）；已接种百白破疫苗者479例（55.9%）；有明确的家庭内咳嗽接触史者492例（57.4%）。患儿均以咳嗽为主要表现，从发病至确诊百日咳中位时间为20 d；有痉挛性咳嗽者836例（97.5%）、面色涨红806例（94.0%）、口周发绀308例（35.9%）、气喘269例（31.4%）、鸡鸣样回声248例（28.9%）、呼吸暂停46例（5.4%）；肺部查体有湿啰音761例（88.8%）；发热159例（18.5%）。白细胞计数升高505例（58.9%），外周血淋巴细胞比例升高702例（81.9%），降钙素原（PCT）升高36例（4.2%），高敏C反应蛋白（hsCRP）升高17例（2.0%）；胸部影像学示肺炎673例（78.5%）；血气分析提示低氧血症50例（5.8%），呼吸衰竭9例（1.1%）。857例患儿中，59例为重症百日咳（6.9%）。经治疗，1周内痉挛性咳嗽症状消失者515例（60.1%），明显缓解者198例（23.1%），无死亡病例。结论西安地区百日咳全年散发，7－9月和2－4月多见，农村儿童多见，〈6月龄未完成基础免疫者发病多见，家庭成员是儿童百日咳的重要传染源，其临床表现主要以痉挛性咳嗽为主，一般预后良好。

Objective To analyze the clinical characteristics in children with pertussis, and to provide a scientific basis for treatment of pertussis.Methods Retrospective analysis of general data, symptoms, signs, auxiliary examinations, treatment and prognosis was performed on the patients with pediatric pertussis in Xi′an from January 2015 to December 2016; the epidemiological data were analyzed by using descriptive approach.Results In a total of 857 patients with pertussis, there were 469 males and 388 females （the gender ratio of 1.211.00）, 183 cases （21.3%） from the urban areas and 674 cases （78.7%） from the rural areas.The cases were reported throughout the year, indicating 2 peak times of onset： 355 cases （41.5%） from July to September and 218 cases （25.4%） from February to April.And 473 cases （55.2%） were younger than 6 months; 479 cases （55.9%） were inoculated with diphtheria, tetanus and pertussis combined vaccine（DTP） vaccine; 492 cases （57.4%） were exposed to their family members who coughed at that time.Cough was the main symptom, and the median duration of pertussis from onset to diagnosis was 20 days.Concomitant symptoms included spasmodic cough was relieved in 836 cases （97.5%）, facial suffusion in 806 cases （94.0%）, peri-oral cyanosis in 308 cases （35.9%）, asthma in 269 cases （31.4%）, crow-like echo in 248 cases （28.9%）, and apnea in 46 cases （5.4%）; pulmonary moist rale was found by check-up in 761 cases （88.8%）, and fever was observed in 159 cases （18.5%）. The increased proportion of the peripheral blood lymphocytes was found in 702 cases （81.9%）, the increased total count of leukocytes in 505 cases （58.9%）, the increased procalcitonin（PCT） in 36 cases （4.2%） and the elevated level of high sensitivity C reactive protein（hsCRP） in 17 cases （2.0%）; pneumonia was suggested by chest radiography in 673 cases （78.5%）; in the blood-gas analysis, hypoxemia was suggested in 50 cases （5.8%） and respiratory failure in 9 cases （1.1%）. In the 857 patients with pertussis, 59 cases （6.9%） were with severe-type pertussis.At 1 week of the treatment, no spasmodic cough was reported in 515 cases （60.1%） and obviously relieved spasmodic cough in 198 cases （23.1%）, and no deaths occurred.Conclusions The cases of pertussis occur throughout the year in Xi′an, predominately from July to September and February to April.A higher incidence is reported in the rural areas, compared with the urban areas, particularly in those younger than 6 months with incomplete DTP vaccination, who usually have severe conditions.In many cases, those with pediatric pertussis are infected by family members; most of them have spasmodic cough with good prognosis, without typical clinical signs.