百日咳流行病学、临床特征和重症百日咳148例危险因素分析

Epidemiology,Clinical Characteristics and Risk Factors of 148 Severe Pertussis Cases in Yunnan

目的分析昆明市儿童医院住院的百日咳患者在云南省的地区的分布情况、流行病学特征、临床症状、重症百日咳的高危因素等,探讨百日咳的流行病学、临床特征及重症百日咳的高危因素。方法收集昆明市儿童医院2020年1月至2021年12月收治的居住地为云南的148例百日咳患儿资料,按地区分布情况、不同年龄组、临床症状、实验室辅助检查结果、病情的严重程度等,对各组资料进行回顾性对比分析。结果148例患儿中,男性96例(64.86%)、女性52例(35.14%),148例百日咳患儿中123例(83.11%)为普通型,25例(16.89%)为重症百日咳,<3月龄患儿占27.03%、3月龄~6月龄占33.11%、6月龄~3岁占23.65%、≥3岁占16.22%,感染时未免疫的有94例(63.51%)、咳嗽时有鸡鸣声的有51例(34.46%)、咳嗽时发绀的有26例(17.57%)、合并肺炎的有128例(86.49%)、有既往史的有93例(62.84%)、白细胞(10~30×10^(9)/L)的有85例(57.43%)、白细胞≥30×10^(9)/L的有12例(8.11%)、CRP增高的有9例(6.08%)、住院时间中位数为9 d,有6例使用呼吸机。与普通病例组相比,<3月龄(χ^(2)=29.480,P<0.001)、未免疫(χ^(2)=7.783,P=0.005)、咳嗽时发绀(χ^(2)=21.850,P<0.001)、有既往史(χ^(2)=8.156,P<0.001)的重症患者占比更高,差异均有统计学意义;重症百日咳住院时间明显高于普通病例(Z=-6.712,P<0.001),差异有统计学意义。经百日咳的多因素Logistic回归分析显示:咳嗽时发绀(OR=0.275,P<0.001)、有既往史(OR=0.188,P=0.008)、使用呼吸机(OR=0.141,P<0.001)。结论咳嗽时发绀、有既往史、使用呼吸机是重症百日咳的危险因素。建议有既往史的婴儿若无禁忌症应尽快按时接种百日咳疫苗,<3月龄儿童确诊百日咳后,特别是需要机械通气的患者,应加强呼吸道管理及症状、体征的观察,避免发展成重症。

Objective To analyze the distribution,epidemiological characteristics,clinical symptoms and high-risk factors of pertussis in Yunnan Province,and to explore the epidemiology,clinical characteristics and high-risk factors of pertussis.Methods Data of 148 children with pertussis who were admitted to Kunming Children’s Hospital from January 2020 to December 2021 in Yunnan province were collected and retrospectively analyzed based on regional distribution,age,clinical manifestation,laboratory test results and severity of disease.Results Among the 148 children,96 cases(64.86%)were male and 52 cases(35.14%)were female;123 cases(83.11%)were common type,25(16.89%)were severe pertussis.Children aged under 3 months accounted for 27.03%,children aged 3 months to 6 months accounted for 33.11%,children aged from 6 months to 3 years accounted for 23.65%,children aged≥3 years accounted for 16.22%.94 cases(63.51%)were not immunized at the time of infection.51 cases(34.46%)had chicken crowing during cough,and 26 cases(17.57%)had cyanosis during cough.There were 128 cases(86.49%)complicated with pneumonia,93 cases(62.84%)with past history.There were 85 cases(57.43%)with WBC(10~30)×10^(9)/L and 12 cases(8.11%)with WBC≥30×10^(9)/L.There are 9 cases(6.08%)with increased CRP.The median length of hospital stay was 9 days,and 6 children used ventilator.Compared with the moderate cases,the proportion of severe patients with<3 months old(χ^(2)=29.480,P<0.001),non immunization(χ^(2)=7.783,P=0.005),cyanosis during cough(χ^(2)=21.850,P<0.001)and past history(χ^(2)=8.156,P<0.001)was higher,and the difference was statistically significant.The length of hospital stay of severe pertussis was significantly higher than that of moderate cases(Z=-6.712,P<0.001).Multivariate logistic regression analysis of pertussis showed that cyanosis during cough(OR=0.275,P<0.001),previous history(OR=0.188,P=0.008)and use of ventilators(OR=0.141,P<0.001).Conclusion As cyanosis during cough,previous history and use of ventilator are the risk factors of severe pertussis,it is recommended that infants with past history should be vaccinated against pertussis as soon as possible if there are no contraindications.After the diagnosis of pertussis in children under 3 months,especially those who need mechanical ventilation,respiratory tract management and observation of symptoms and signs should be strengthened to avoid developing into severe pertussis.