新生儿呼吸道合胞病毒急性下呼吸道感染的临床研究

Clinical study of acute lower respiratory tract infection caused by respiratory syncytial virus in neonates

目的探讨新生儿呼吸道合胞病毒(RSV)急性下呼吸道感染(ALRTI)的临床特点,并分析其重症感染的相关因素。方法收集2014年1月至2020年12月深圳市儿童医院收治的399例RSV核酸或抗原阳性的新生儿ALRTI临床资料,回顾性分析其临床特征;根据严重度指数(SI)分为轻中症感染组和重症感染组,对2组临床资料进行比较,并运用多因素Logistic回归分析新生儿发生RSV重症ALRTI的相关因素。结果1.共纳入399例,其中男239例(59.9%),女160例(40.1%),男女比例1.49∶1.00;轻中症组349例(87.5%),重症组50例(12.5%)。发病月份集中于3-10月。2.轻中症组与重症组在早产[15例(4.3%)比9例(18.0%)]、低出生体质量[11例(3.2%)比6例(12.0%)]、既往住院史[12例(3.4%)比5例(10.0%)]、母乳喂养[167例(47.9%)比16例(32.0%)]方面比较,差异均有统计学意义(χ^(2)=14.524、8.394、4.616、4.426,均P<0.05)。3.轻中症组与重症组在发热[78例(22.4%)比18例(36.0%)]、气促[156例(44.7%)比36例(72.0%)]、纳差[48例(13.8%)比15例(30.0%)]、喘憋[20例(5.7%)比10例(20.0%)]、发绀[30例(8.0%)比16例(32.0%)]、精神状态(烦躁/萎靡)[20例(5.7%)比8例(16.0%)]、咳嗽天数[(8.1±2.6)d比(9.4±2.9)d]方面比较,差异均有统计学意义(χ^(2)=4.460、13.057、8.682、12.806、23.486、7.068,t=-3.054,均P<0.05);重症组体征以肺部湿啰音[29例(58.0%)比114例(32.7%)]及三凹征[14例(28.0%)比20例(5.7%)]多见,轻中症组体征以肺部痰鸣音[168例(48.1%)比14例(28.0%)]多见,差异均有统计学意义(χ^(2)=12.208、27.823、7.149,均P<0.05)。4.Logistic回归多因素分析发现,早产为新生儿RSV致重症ALRTI的独立危险因素(OR=3.717,95%CI:1.257~10.987),气促(OR=2.216,95%CI:1.061~4.629)、发绀(OR=3.621,95%CI:1.638~8.004)、三凹征(OR=2.688,95%CI:1.077~6.711)可能是重症感染的预测因素。结论早产儿感染RSV易发展成重症感染,新生儿RSV感染有气促/发绀/三凹征表现者需警惕为重症感染。

Objective To investigate the clinical characteristics of acute lower respiratory tract infection(ALRTI)in neonates caused by respiratory syncytial virus(RSV),and to analyze the factors associated with the severe infection.Methods Clinical data of 399 ALRTI neonates with positive nucleic acids or antigen of RSV admitted to Shenzhen Children′s Hospital from January 2014 to December 2020 were retrospectively analyzed for their clinical cha-racteristics.They were divided into mild-to-moderate group and severe group according to the severity index(SI),and the clinical data of the 2 groups were compared.Relevant factors of severe ALRTI of RSV in neonates were analyzed by multivariate Logistic regression.Results (1)A total of 399 ALRTI neonates with RSV infection were included,involving 239 males(59.9%)and 160 females(40.1%)with a male-to-female ratio of 1.49∶1.00.There were 349 cases(87.5%)and 50 cases(12.5%)in the mild-to-moderate group and severe group,respectively.The disease mainly occurred from March to October.(2)There were significant differences in the preterm delivery[15 cases(4.3%)vs.9 cases(18.0%)],low birth weight[11 cases(3.2%)vs.6 cases(12.0%)],previous hospitalization history[12 cases(3.4%)vs.5 cases(10.0%)],and breastfeeding[167 cases(47.9%)vs.16 cases(32.0%)]between the mild-to-moderate group and severe group(χ^(2)=14.524,8.394,4.616 and 4.426,respectively,all P<0.05).(3)There were significant differences in fever[78 cases(22.4%)vs.18 cases(36.0%)],shortness of breath[156 cases(44.7%)vs.36 cases(72.0%)],poor appetite[48 cases(13.8%)vs.15 cases(30.0%)],wheezing[20 cases(5.7%)vs.10 cases(20.0%)],cyanosis[30 cases(8.0%)vs.16 cases(32.0%)]and mental status(irritability/malaise)[20 cases(5.7%)vs.8 cases(16.0%)],and duration of cough[(8.1±2.6)days vs.(9.4±2.9)days]between the mild-to-moderate group and severe group(χ^(2)=4.460,13.057,8.682,12.806,23.486 and 7.068,t=-3.054,all P<0.05).Moist rales in the lungs[29 cases(58.0%)vs.114 cases(32.7%)]and three concave signs[14 cases(28.0%)vs.20 cases(5.7%)]were commonly found in the severe group,while pulmonary phlegm sounds[168 cases(48.1%)vs.14 cases(28.0%)]was commonly found in the mild-to-moderate group,and the differences were statistically significant(χ^(2)=12.208,27.823 and 7.149,respectively,all P<0.05).(4)Multifactorial analysis showed that premature delivery was an independent risk factor for the development of severe ALRTI caused by RSV in neonates(OR=3.717,95%CI:1.257-10.987),and shortness of breath(OR=2.216,95%CI:1.061-4.629),cyanosis(OR=3.621,95%CI:1.638-8.004)and three concave signs(OR=2.688,95%CI:1.077-6.711)may be early warning factors for the severe condition.Conclusions Preterm infants with RSV infection are prone to develop into severe disease,and neonates with RSV infection with shortness of breath,cyanosis and three concave signs as symptoms of severe infection should be well concerned for a close monitoring.