下呼吸道病毒感染患儿并发急性支气管哮喘因素的研究

Study on the factors of complicated acute bronchial asthma in children with lower respiratory tract virus infection

目的分析儿童下呼吸道病毒感染的临床流行特征,探讨并发急性支气管哮喘的相关因素。方法选取2018年10月至2019年10月在苏州市立医院本部儿科门诊就诊的≤14岁的下呼吸道感染(LRTI)患儿1025例,经直接免疫荧光法进行咽拭子病毒检测,将病毒检测为阳性的298例患儿,按是否并发急性支气管哮喘分为发生组(35例)和未发生组(263例)。分析下呼吸道病毒感染患儿的临床特征及影响其并发急性支气管哮喘的危险因素。结果在1025例LRTI患儿中,下呼吸道病毒感染发生率为29.07%,其中感染呼吸道合胞病毒(RSV)占比最高(67.79%);不同年龄段、发病季节、入院诊断类型的分布差异均有统计学意义(χ^(2)值分别为23.562、18.583、16.254,P<0.001)。在298例下呼吸道病毒感染患儿中,并发急性支气管哮喘发生率为11.74%;发生组年龄为29天~<1岁、过敏史、特异性皮炎史、哮喘家族史、血清总IgE>120IU/L占比均高于未发生组,差异均有统计学意义(χ^(2)值分别为6.773、12.734、24.990、15.524、17.987,P<0.001)。多因素Logistic回归分析显示,过敏史(OR=3.271,95%CI:1.210~5.955)、特异性皮炎史(OR=4.730,95%CI:1.641~8.236)、哮喘家族史(OR=3.615,95%CI:1.345~6.475)、血清总IgE>120IU/L(OR=4.059,95%CI:1.530~6.765)均是影响下呼吸道病毒感染患儿并发急性支气管哮喘的独立危险因素,差异均有统计学意义(P<0.001)。结论病毒是LRTI患儿重要的病原,临床流行特征以1岁以下儿童、冬季发病为主,且有一定并发急性支气管哮喘的风险,过敏史、特异性皮炎史等均是影响下呼吸道病毒感染患儿并发急性支气管哮喘的独立危险因素。

Objective To analyze the clinical epidemiological characteristics of lower respiratory tract virus infection in children and explore the related factors of complicated acute bronchial asthma.Methods A total of 1025 children with lower respiratory tract infection(LRTI)treated in the pediatric clinic of Suzhou Municipal Hospital from October 2018 to October 2019 were selected.Nasopharyngeal swabs were collected for virus detection by the direct immunofluorescence method.The 298 children who tested positive for the virus were divided into the occurrence group(35 cases)and the non-occurring group(263 cases)according to whether they were complicated by acute bronchial asthma.The clinical epidemiological characteristics and risk factors of acute bronchial asthma in children with lower respiratory tract virus infection were analyzed.Results The incidence of lower respiratory tract virus infection in 1025 children with LRTI was 29.07%,and respiratory syncytial virus(RSV)infection accounted for the highest proportion(67.79%).There were significant differences in the distribution of different age groups,onset seasons,and types of admission diagnosis(χ^(2)=23.562,18.583 and 16.254,respectively,P<0.001).Among 298 children with lower respiratory tract virus infection,the incidence of complicated acute bronchial asthma was 11.74%.The proportions of 29 days≤age<1 year,history of allergy,history of atopic dermatitis,family history of asthma,serum total IgE>120 IU/L in the occurrence group were higher than those of the non-occurrence group,and the differences were statistically significant(χ^(2)=6.773,12.734,24.990,15.524 and 17.987,respectively,P<0.001).Multivariate Logistic regression analysis showed that history of allergy(OR=3.271,95%CI:1.210-5.955),history of specific dermatitis(OR=4.730,95%CI:1.641-8.236),family history of asthma(OR=3.615,95%CI:1.345-6.475)and serum total IgE>120 IU/L(OR=4.059,95%CI:1.530-6.765)were independent risk factors for complicated acute bronchial asthma in children with lower respiratory tract virus infection,and the differences were statistically significant(P<0.001).Conclusion Virus is an important pathogen in children with LRTI.The main clinical epidemiological characteristics are children under 1 year old and onset in winter,and there is a certain risk of complicated acute bronchial asthma.Allergic history and specific dermatitis are independent risk factors of complicated acute bronchial asthma in children with lower respiratory tract virus infection.