儿童麻疹并发肺炎的危险因素分析

Analysis of risk factors for measles complicated with pneumonia in children

目的通过调查麻疹患儿的人口学、流行病学与临床特征,探讨儿童麻疹并发肺炎的危险因素。方法纳入2014年1月1日至2018年12月31日于山东大学附属济南市传染病医院住院治疗的年龄≤18岁的麻疹患儿,收集其人口学、流行病学、临床与实验室检查资料,分析麻疹并发肺炎的特征。统计学分析采用χ^2检验,并以多因素回归分析儿童麻疹并发肺炎的危险因素。结果共纳入1730例麻疹患儿,其中2014年423例(24.5%),2015年437例(25.3%),2016年856例(49.5%),2017年10例(0.6%),2018年4例(0.2%);男女性别比为2∶1;年龄为4 d至18岁,<3岁者1572例(90.9%);居住地为农村者1381例(79.8%);低出生体质量儿83例(4.8%);229例(13.2%)患儿在患麻疹前半年内有呼吸道疾病史;1489例(86.1%)患儿未接种过麻疹疫苗。根据是否并发肺炎,将1730例麻疹患儿分成肺炎组1295例与非肺炎组435例。肺炎组呛咳发生率为56.8%(735/1295),高于非肺炎组的40.9%(178/435),差异有统计学意义(χ^2=32.770,P<0.01)。0.7%(12/1730)的患儿病情危重,0.5%(8/1730)的患儿死亡,均为肺炎组患儿。肺炎组患儿白细胞计数、白细胞计数>10×109/L所占比例、中性粒细胞计数、中性粒细胞计数>7×109/L所占比例、C反应蛋白(C reactive protein,CRP)、CRP>8.2 mg/L所占比例、降钙素原、降钙素原>0.5 ng/L所占比例、血红蛋白<110 g/L所占比例、白蛋白<35 g/L所占比例均高于非肺炎组,差异均有统计学意义(t=7.153、χ^2=47.239、t=8.297、χ^2=41.176、Z=-6.769、χ^2=40.131、Z=-4.119、χ^2=19.284、χ^2=7.465、χ^2=18.356,均P<0.01)。性别[比值比(odds ratio,OR)=1.316]、居住地为农村(OR=1.521)、年龄<3岁(OR=2.044)、出生体质量<2.5 kg(OR=2.014)、发病前有呼吸道疾病(OR=1.905)、未接种过麻疹疫苗(OR=1.591)、感染麻疹病毒后出现呛咳(OR=1.550),以及中性粒细胞计数>7×109/L(OR=3.666)、C反应蛋白>8.2 mg/L(OR=1.871)、降钙素原>0.5 ng/L(OR=1.711)是儿童麻疹并发肺炎的独立危险因素(均P<0.05)。结论应进一步加强儿童麻疹疫苗的接种工作。男性、来自农村、低出生体质量儿、患麻疹前有呼吸道疾病史、未接种过麻疹疫苗的麻疹患儿易并发肺炎,应给予特别的医学关注。

Objective To investigate the demographic,epidemiological and clinical characteristics of measles in children,and to explore the risk factors for measles complicated with pneumonia in children.Methods Children with measles aged≤18 years who were hospitalized in Jinan Infectious Disease Hospital from January 1,2014 to December 31,2018 were included.The demographic,epidemiological,clinical and laboratory data of inpatients were collected.The features of patients with pneumonia were analyzed.The risk factors of pneumonia were analyzed by chi-square test and multivariate logistic regression.Results A total of 1730 patients were recruited,including 423 patients(24.5%)in 2014,437 patients(25.3%)in 2015,856 patients(49.5%)in 2016,10 patients(0.6%)in 2017 and four patients(0.2%)in 2018.The male to female ratio was 2∶1.The age ranged from four days to 18 years,and 1572 patients(90.9%)were under three years old.There were 1381 patients(79.8%)living in rural areas and 83 patients(4.8%)born with low birth weight.Two hundred and twenty-nine patients(13.2%)had a history of respiratory diseases within half a year before measles onset,and 1489 patients(86.1%)had not been vaccinated before.According to the presence of pneumonia,1730 children with measles were divided into pneumonia group(n=1295)and non-pneumonia group(n=435).There were more patients with bucking in pneumonia group than those in non-pneumonia group(56.8%(735/1295)vs.40.9%(178/435),χ2=32.770,P<0.01).Zero point seven percent(12/1730)of children were critically ill,and 0.5%(8/1730)of children died,all of whom were in pneumonia group.The white blood cell count,the percentage of white blood cell count>10×109/L,neutrophilic granulocyte count,the percentage of neutrophilic granulocyte count>7×109/L,C reactive protein level,the percentage of C reactive protein level>8.2 mg/L,procalcitonin level,the percentage of procalcitonin>0.5 ng/L,the percentage of hemoglobin level<110 g/L,and the percentage of albumin<35 g/L in pneumonia group were all significantly higher than those in non-pneumonia group(t=7.153,χ2=47.239,t=8.297,χ2=41.176,Z=-6.769,χ2=40.131,Z=-4.119,χ2=19.284,χ2=7.465,χ2=18.356,respectively,all P<0.01).Multivariate logistic regression analysis showed that male(odds ratio(OR)=1.316),living in rural areas(OR=1.521),age<three years old(OR=2.044),birth weight<2.5 kg(OR=2.014),respiratory diseases(OR=1.905),without measles vaccination(OR=1.591),bucking(OR=1.550),neutrophilic granulocyte count>7×109/L(OR=3.666),and C reactive protein level>8.2 mg/L(OR=1.871),procalcitonin>0.5 ng/L(OR=1.711)were independent risk factors for pneumonia in children with measles.Conclusions Measles vaccination in children should be farther strengthened.Male,children living in rural areas,low birth weight,history of respiratory diseases before measles and without measles vaccination are prone to be complicated with pneumonia,and special medical attention should be given.