32例湖北省新型冠状病毒肺炎患儿临床研究

Clinical research of 32 children with coronavirus disease 2019 in Hubei Province

目的探讨湖北省新型冠状病毒肺炎(新冠肺炎)患儿的临床特点.方法收集2020年1月21日至2月14日在华中科技大学同济医学院附属武汉儿童医院住院确诊为新冠肺炎并给予中医治疗的32例患儿入院时的临床资料,包括一般资料、流行病学资料、血常规、病原学资料〔新型冠状病毒(2019-nCoV)核酸检测、呼吸道病原学9项、血培养、痰培养〕、临床分型、中医临床症状及舌象、脉象、指纹和中医证型、治疗经过和预后.分析新冠肺炎患儿的临床特点.结果32例新冠肺炎患儿中男性25例,女性7例;中位年龄83.02(2.50~180.67)个月.所有患儿均在湖北省武汉市居住,其中亲属为新冠肺炎患者28例,无明确接触史患儿4例.32例患儿血常规提示白细胞计数(WBC)升高2例(分别为16.09×10^(9)/L和18.16×10^(9)/L),正常29例〔正常参考值(3.85~10.00)×10^(9)/L〕,降低1例(0.75×10^(9)/L);淋巴细胞计数(LYM)偏低1例(0.19×10^(9)/L).病原学提示合并支原体感染10例,甲型流感1例,细菌感染3例;临床分型为轻型30例,重型2例.32例患儿中医证候表现为发热、咳嗽、恶寒、肌肉酸痛、头痛、胸闷、咽痛、呕吐、腹痛、纳差、腹泻、抽搐,其中发热(71.88%)、咳嗽(68.75%)、纳差(40.62%)、腹泻(15.62%)居前4位;舌象以舌红(53.12%)、黄腻苔(87.50%)为主,脉象以滑脉为主(62.50%),指纹以紫色为主(31.25%);中医证型以疫毒郁肺为主(53.13%).经过抗病毒、中药及针对合并症及感染的治疗,全部病例治愈出院.结论湖北省儿童新冠肺炎的临床特点为以家庭聚集感染为主;无明显WBC及LYM降低;需要注意支原体、流感病毒及细菌合并感染;临床分型以轻型居多;中医证型以疫毒郁肺为主.中西医结合治疗儿童新冠肺炎取得较好临床疗效.

Objective To investigate the clinical characteristics of children's coronavirus disease 2019(COVID-19)in Hubei Province.Methods The epidemiological and clinical data of 32 children admitted to Wuhan Children's Hospital from January 21 to February 14,2020 who were diagnosed with COVID-19 and given traditional Chinese medicine(TCM)treatment or guidance were collected,including general data,epidemiological data,blood routine,etiological data[2019 novel coronavirus(2019-nCoV)nucleic acid test,nine items of respiratory pathogens,blood culture,sputum culture],elinical classification,TCM clinical symptoms and tongue appearance(coating,proper),pulse condition or fingerprint,TCM syndromes,treatment process and prognosis.The clinical characteristics of COVID-19 in children were analyzed.Results Among the 32 children with COVID-19,25 cases were male and 7 cases were female,with median age of 83.02(2.50-180.67)months.All the children lived in Wuhan,Hubei Province,of which 28 had relatives with COVID-19 and 4 had no clear contact history.Blood routine examination of 32 children showed that the white blood cell count(WBC)was increased in 2 cases(16.09×10^(9)/L and 18.16×10^(9)/L,respectively),normal in 29 cases[normal reference value of(3.85-10.00)×10^(9)/L],and decreased in 1 case(0.75×10^(9)/L).The lymphocyte count(LYM)in 1 case decreased(0.19×10^(9)ZL);etiology indicated that 10 cases were complicated with mycoplasma infection,1 case with influenza A and 3 cases with bacterial infection;the clinical types were mild in 30 cases and severe in 2 cases.The manifestations of TCM syndromes in 32 children were fever,cough,chills,muscle ache,headache,chest distress,phaiyngeal pain,vomiting,abdominal pain,poor appetite,diarrhea,and convulsion,among which fever(71.88%),cough(68.75%),poor appetite(40.62%)and diarrhea(15.62%)were the top 4;tongue coating was mainly red tongue(53.13%)and yellow greasy moss(87.50%),pulse condition was mainly smooth pulse(62.50%),fingerprint was mainly purple in color(31.25%);the main syndrome type of TCM was epidemic toxin stagnation in lung(53.13%).After antiviral,Chinese medicine treatment and treatment for complications and infections,all cases were cured and discharged.Conclusions The clinical characteristics of children with COVID-19 in Hubei Province are mainly household contact cases.There was no significant decrease in LYM and WBC.Attention should be paid to mycoplasma,influenza A or bacterial co-infection.Mild pneumonia were the majority.The TCM classification is mainly epidemic toxin stagnation in lung.