腺病毒肺炎患儿并发喘息的危险因素分析

Risk factors for wheezing in children with adenovirus pneumonia

目的探讨儿童腺病毒(human adenovirus,HAdV)肺炎并发喘息的相关危险因素。方法回顾性分析中国医科大学附属盛京医院儿科2019年1至12月期间因HAdV肺炎住院的2~5岁患儿97例、同期同龄非HAdV肺炎患儿100例的临床资料,再根据住院时有无喘息将97例HAdV肺炎患儿分为喘息组和非喘息组。对HAdV肺炎组、非HAdV肺炎组患儿的一般特征、临床特征、实验室检查资料进行统计学分析,并应用多因素Logistic回归分析HAdV肺炎并发喘息的危险因素。结果HAdV肺炎组患儿发热时间较非HAdV肺炎组延长,重症肺炎例数、喘息例数、WBC计数较非HAdV肺炎组明显增加,差异有统计学意义(P<0.05);而住院时间、实验室检查CRP、ALT、Cr、肌酸激酶(creatine kinase,CK)、肌酸激酶同工酶(CKMB)、乳酸脱氢酶(lactic dehydrogenase,LDH)水平与非HAdV肺炎组比较差异无统计学意义(P>0.05)。其中52.6%(51/97)的HAdV肺炎患儿出现喘息。HAdV肺炎患儿中喘息组与非喘息组比较:喘息组患儿既往有喘息史例数、特应性体质例数、重症肺炎例数、嗜酸性粒细胞(eosnophils,EO)计数、肺CT提示小气道改变例数较非喘息组患儿明显增加,差异有统计学意义(P<0.05);而特应性体质家族史、住院时间、发热时间、WBC计数、淋巴细胞(lymphocyte,LY)计数、CRP水平、伴有混合感染及肺实变的例数在两组间比较差异无统计学意义(P>0.05)。对HAdV肺炎患儿并发喘息的相关危险因素进行多因素Logistic回归分析结果显示:HAdV感染的重症肺炎患儿出现喘息的风险是非重症肺炎患儿的2.949倍;有特应性体质的HAdV肺炎患儿出现喘息的风险是无特应性体质患儿的3.930倍。结论HAdV肺炎患儿喘息的发生率高于非HAdV肺炎患儿,重症肺炎、有特应性体质是HAdV肺炎患儿并发喘息的独立危险因素。

Objective To investigate the risk factors for wheezing in the children with HAdV pneumonia.Methods Ninety-seven cases of children aged 2 to 5 years with HAdV pneumonia were selected from Pediatric Department of Shengjing Hospital of China Medical University from January 2019 to December 2019.Meanwhile,100 children of the same age without adenovirus pneumonia were recruited as the control group.According to whether wheezing or not,the children with HAdV pneumonia were divided into wheezing group and non-wheezing group.The general characteristics,clinical characteristics and laboratory examination data of HAdV pneumonia group and non-HAdV pneumonia group were statistically analyzed,and the risk factors of wheezing after HAdV pneumonia were analyzed by multivariate logistic regression.Results Compared with the non-HAdV group,fever duration,serious cases,cases of wheezing in HAdV group were significant different(P<0.05).In laboratory examination,the white blood cell(WBC)count in HAdV group was significantly higher than those in control group(P<0.05).Whereas,hospitalization time,C-reactive protein(CRP),alanine aminotransferase(ALT),creatinine(Cr),creatine kinase(CK),CKMB,and lactic dehydrogenase(LDH)levels in HAdV group were not statistically significant compared with those of the children in non-HAdV pneumonia group(P>0.05).Wheezing occurred in 52.6%(51/97)of children with HAdV pneumonia.Compared with the non-wheezing group,history of wheezing,cases with atopy,serious cases,eosinophils(EO)count,and cases with small airway changes in wheezing group were significantly different(P<0.05).Whereas,atopic family history,hospitalization time,fever duration,lymphocyte(LY)count,WBC count,CRP level,the cases with co-infection and consolidation in lung images in wheezing group were not statistically significant compared with those of the children in non-wheezing group(P>0.05).Multivariate logistic regression analysis showed that the risk of wheezing in children with severe HAdV pneumonia was 2.949 times as much as those without severe HAdV pneumonia.The risk of wheezing in children with HAdV pneumonia with atopic constitution was 3.930 times as much as those without atopiy.Conclusion The incidence of wheezing in children with HAdV pneumonia is higher than those in children of non-HAdV pneumonia.Severe cases and atopy are the independent risk factors for wheezing in the children with HAdV pneumonia.