基于临床特征的儿童重症百日咳早期预警危险因素Meta分析

Risk factors for early warning of severe pertussis in children based on clinical features: a meta-analysis

目的基于临床特征探讨早期预警儿童重症百日咳的危险因素。方法通过PubMed、Embase、ovid、Web of Science、万方、中国知网等数据库检索截至2019年9月1日发表的儿童重症百日咳危险因素的观察性研究文献,应用Stata12.0软件进行Meta分析。结果纳入10篇观察性研究,包括210例重症和2233例非重症百日咳患儿。与非重症患儿相比,重症患儿中早产、<3月龄、患有先天性心脏病、有接触史、呼吸困难、紫绀、呼吸暂停、惊厥的比例更高[OR(95%CI):3.53(2.30-5.42)、4.04(2.84-5.75)、2.27(1.13-4.57)、4.28(2.76-6.63)、2.46(1.36-4.44)、3.88(1.93-7.83)、2.29(1.44-3.62)、4.14(2.22-7.72)],合并肺炎、RSV感染、其他感染、任何并发症的几率更高[OR(95%C I):12.12(3.98-36.85)、2.76(1.29-5.91)、3.48(1.95-6.22)、2.91(1.25-6.80)],疫苗接种的比例更低[OR(95%C I):0.48(0.31-0.74)];重症百日咳患儿的白细胞计数更高、淋巴细胞计数更高、年龄更小、体重更轻、呼吸频率增快、心率增快、住院时间更长[WMD(95%CI):15.43(11.03-19.83)、8.17(4.42-11.92)、-0.79(-1.17^-0.41)、-1.36(-1.86^-0.86)、26.29(10.03-42.55)、28.35(22.26-34.43)、9.60(5.07-14.13)]。结论儿童百日咳向重症发展与多种临床因素相关,临床上应对这些危险因素早期识别和干预以改善预后;建议加强适龄儿童的百日咳疫苗接种。

Objective To identify risk factors based on clinical features for early warning of severe pertussis in children. Methods We used Pubmed, Embase, ovid, Web of Science, Wanfang Data and CNKI databases to search for observational studies on risk factors of severe pertussis published before September 1, 2019. We conducted a metaanalysis using Stata 12.0 software. Results We included 10 observational studies comprising 210 severe and 2 233 nonsevere pertussis cases. Compared with non-severe pertussis, a higher proportion of severe pertussis occurred among premature-birth children, infants <3 months of age, infants with congenital heart disease, those with a history of contact with a pertussis case, and those with dyspnea, cyanosis, apnea, or convulsions [OR(95%CI): 3.53(2.30-5.42), 4.04(2.84-5.75), 2.27(1.13-4.57), 4.28(2.76-6.63), 2.46(1.36-4.44), 3.88(1.93-7.83), 2.29(1.44-3.62), 4.14(2.22-7.72)];a higher proportion of severe pertussis occurred among those who developed pneumonia, had RSV infection, had other infections, and had other complications [OR(95%CI): 12.12(3.98-36.85), 2.76(1.29-5.91), 3.48(1.95-6.22), 2.91(1.25-6.80)];a higher proportion of sever pertussis occurred among those with a lower vaccination rate [OR(95%CI): 0.48(0.31-0.74)]. Individuals with severe pertussis had higher white blood cell counts, higher lymphocyte counts, lower ages, lower weights, faster respiratory rates, faster heart rates, and longer hospitalization stays [WMD(95%CI): 15.43(11.03-19.83), 8.17(4.42-11.92),-0.79(-1.17^-0.41),-1.36(-1.86^-0.86), 26.29(10.03-42.55), 28.35(22.26-34.43), 9.60(5.07-14.13)]. Conclusion Severe pertussis in children was associated with a variety of clinical risk factors. Early identification and intervention of these factors may improve prognosis. We recommend strengthening pertussis vaccination of ageeligible children.