呼吸道合胞病毒急性下呼吸道感染门诊患儿临床特征、住院及再发喘息随访研究

Clinical features and follow-up for hospitalization and recurrent wheezing in outpatient infants with RSV-acute lower respiratory tract infection

目的:研究呼吸道合胞病毒(respiratory syncytial virus,RSV)引起的急性下呼吸道感染门诊患儿临床特征、住院及再发喘息情况。方法:收集2016年10月至2017年3月在重庆医科大学附属儿童医院门诊就诊的2岁以下急性下呼吸道感染(acute lower respiratory infection,ALRI)患儿鼻咽抽吸物,采用PCR方法检测16种常见的呼吸道病毒,对比分析RSV检出患儿的临床特征。分别在入组2周和6个月后对患儿进行住院和再发喘息随访,对导致RSV感染住院和再发喘息危险因素进行logistic回归分析。结果:共收集457例2岁以下的ALRI门诊患儿,400例(87.5%)患儿病毒检出阳性,其中单一RSV检出271例(59.3%),RSV混合其他病毒检出54例(11.8%),其他病毒检75例(16.4%),未检出病毒者57例(12.5%)。与后2组患儿比较,单一RSV检出和RSV混合其他病毒检出组更易出现发热、喘息及呼吸困难症状(均P<0.0083)。单一RSV检出患儿住院者有29例(住院率11.4%),其年龄显著小于未住院患儿(P=0.001)。Logistic分析示年龄(OR=0.766,95%CI=0.649~0.904,P=0.002)是单一RSV检出ALRI患儿住院的保护因素,而早产(OR=5.306,95%CI=1.106~25.459,P=0.037)是其危险因素。对216例6个月随访成功的毛细支气管炎患儿分析后发现,单一RSV检出毛细支气管炎患儿6个月内再发喘息和反复喘息的比例分别是25.9%和15.8%;logistic回归分析发现早产是RSV毛细支气管炎患儿反复喘息发作的危险因素(OR=5.383,95%CI=1.127~25.705,P=0.035)。结论:RSV感染ALRI患儿易出现发热、喘息和呼吸困难。小年龄和早产是RSV相关ALRI患儿住院的危险因素;早产还是RSV感染毛细支气管炎患儿后短期内反复喘息发作的危险因素。

Objective:To investigate the clinical features,hospitalization,and recurrent wheezing in outpatient infants with respiratory syncytial virus(RSV)-induced acute lower respiratory tract infection(ALRI).Methods:Outpatient infants under two years who were diagnosed with ALRI from October 2016 to March 2017 were enrolled.PCR was applied to detect 16 common respiratory viruses in nasopharyngeal aspirates(NPAs).Clinical features of RSV-positive patients were comparatively analyzed.The infants were followed up for hospitalization and recurrent wheezing at 2 weeks and 6 months after enrollment,respectively.Logistic regression was used to analyze the risk factors for hospitalization and recurrent wheezing due to RSV infection.Results:A total of 457 outpatient infants under two years with ALRI were recruited,400(87.5%)out of whom tested positive for viruses,including single RSV detected in 271(59.3%)cases,RSV co-detected with other viruses in 54(11.8%)cases,and other viruses in 75(16.4%)cases;57(12.5%)cases were negative for viruses.Compared with the latter two groups,the infants positive for RSV alone and those positive for RSV and other viruses were more likely to show the symptoms of fever,wheezing,and dyspnea(P<0.0083).Twenty-nine(11.4%)of single RSV-positive patients were hospitalized,and they were significantly younger than those who were not hospitalized(P=0.001).Logistic regression analysis showed that in single RSV-positive infants with ALRI,age(OR=0.766,95%CI=0.649 to 0.904,P=0.002)was a protective factor against hospitalization,and preterm birth(OR=5.306,95%CI=1.106 to 25.459,P=0.037)was a risk factor for hospitalization.A 6-month follow-up study of 216 infants with capillary bronchiolitis showed that the single RSV-positive infants with capillary bronchiolitis had incidence rates of secondary wheezing and recurrent wheezing of 25.9%and 15.8%,respectively.Logistic regression analysis found that preterm birth was a risk factor for recurrent wheezing in RSV-positive infants with capillary bronchiolitis(OR=5.383,95%CI=1.127 to 25.705,P=0.035).Conclusions:Infants with RSV-ALRI are prone to fever,wheezing,and dyspnea.Early age and preterm birth are risk factors for hospitalization in infants with RSV-ALRI.Preterm birth is also a risk factor for recurrent wheezing in the short term in infants with RSV-capillary bronchiolitis.