新冠疫情前后小儿毛细支气管炎临床特征和病原学变化

Clinical characteristics and etiological changes of bronchiolitis before and after COVID-19 pandemic

目的探讨新冠疫情前后毛细支气管炎患儿临床特征和病原学变化,为毛细支气管炎临床诊治提供依据。方法以2020年1月31日为时间节点,回顾性分析新冠疫情前(2019年2月1日至2020年1月31日,为2019-2020组)与新冠疫情后(2020年2月1日至2021年1月31日,为2020-2021组)苏州大学附属儿童医院呼吸科因毛细支气管炎住院的患儿临床特征和病原学变化。收集病历资料比较一般情况、临床表现和实验室检查,收集鼻咽分泌物检查结果,比较病原学构成差异。结果2019-2020组纳入285例患儿,2020-2021组纳入190例患儿。两组患儿性别、月龄、入院前病程、住院天数差异均无统计学意义(P均>0.05);2020-2021组中/重度病例的比例低于2019-2020组[10.53%(20/190)比21.75%(62/285)],差异有统计学意义(χ^(2)=10.062,P<0.05)。2020-2021组鼻塞流涕症状比例高于2019-2020组、2020-2021组胃肠道症状(呕吐、腹泻)比例低于2019-2020组[57.37%(109/190)比47.37%(135/285)、15.79%(30/190)比24.56%(70/285)],差异有统计学意义(χ^(2)分别为4.563、5.278,P均<0.05);两组患儿发热、呼吸困难症状比例以及气促、紫绀体征比例差异无统计学意义(P均>0.05)。2020-2021组患儿肌酸激酶同工酶低于2019-2020组[4.15(2.90~5.60)比6.70(4.20~22.10)],差异有统计学意义(Z=-8.757,P<0.05);两组患儿的白细胞计数、中性粒细胞比例、血小板计数、嗜酸粒细胞比例、C反应蛋白、谷丙转氨酶、乳酸脱氢酶水平相比差异无统计学意义(P均>0.05)。2020-2021组患儿病原体总检出率、呼吸道合胞病毒阳性率、肺炎支原体阳性率、混合感染率均低于2019-2020组[65.26%(124/190)比75.09%(214/285)、14.21%(27/190)比30.18%(86/285)、6.32%(12/190)比15.09%(43/285)、16.84%(32/190)比25.61%(73/285)],差异有统计学意义(χ^(2)分别为5.361、16.026、8.568、5.094,P均<0.05);2020-2021组患儿鼻病毒阳性率高于2019-2020组[13.16%(25/190)比4.91%(14/285)],差异有统计学意义(χ^(2)=10.285,P<0.05);两组患儿偏肺病毒、博卡病毒、副流感病毒3阳性检出率差异无统计学意义(P均>0.05)。结论新冠疫情前后毛细支气管炎患儿临床特征和病原学发生了变化,疫情防控措施有助于减少相关病原体的传播和减轻疾病的严重程度。

Objective To compare the clinical characteristics and etiology changes of patients with bronchiolitis before the pandemic of coronavirus disease 2019(COVID-19)with those after the pandemic,and to provide a basis for the clinical diagnosis,treatment and prevention of bronchiolitis.Methods Retrospective analysis were made on the clinical characteristics and etiological changes of patients who were hospitalized with bronchiolitis in the Department of Pulmonology,Children′s Hospital of Soochow University before COVID-19 pandemic(from February 1,2019 to January 31,2020,called as Group 2019-2020)and after COVID-19 pandemic(from February 1,2020 to January 31,2021,called as Group 2020-2021).Medical records were reviewed to compare general conditions,clinical manifestations,and laboratory tests.Nasopharyngeal secretion examination results were collected to compare the differences in pathogenic composition.Results A total of 285 patients were enrolled in the Group 2019-2020,while 190 patients in the Group 2020-2021.There were no significant differences in gender,age,symptom duration prior to admission and length of stay between the two groups(P>0.05).The proportion of moderate/severe cases in the Group 2020-2021 was lower than that in the Group 2019-2020[10.53%(20/190)vs 21.75%(62/285)]and the difference was statistically significant(χ^(2)=10.062,P<0.05).The proportion of stuffy nose rhinorrhea in the Group 2020-2021 was higher than that in the Group 2019-2020,while the proportion of gastrointestinal symptoms(vomiting and diarrhea)in the Group 2020-2021 was lower than that in the Group 2019-2020[57.37%(109/190)vs 47.37%(135/285)and 15.79%(30/190)vs 24.56%(70/285)]and the differences were statistically significant(χ^(2) were 4.563 and 5.278 respectively,all P<0.05).There were no significant differences in the proportions of fever,dyspnea,shortness of breath and cyanosis between the two groups(all P>0.05).The creatine kinase isoenzyme(CK-MB)in the Group 2020-2021 was lower than that in the Group 2019-2020[4.15(2.90~5.60)vs 6.70(4.20~22.10)]and the difference was statistically significant(Z=-8.757,P<0.05).There were no statistically significant differences in white blood cell count(WBC),percentage of neutrophil(N%),blood platelet count(PLT),percentage of eosinophil(EOS%),C-reactive protein(CRP),alanine aminotransferase(ALT)and lactate dehydrogenase(LDH)between the two groups(all P>0.05).The total pathogen detection rate,positive rate of respiratory syncytial virus(RSV),positive rate of mycoplasma pneumoniae(MP)and mixed infection rate in the Group 2020-2021 were lower than those in the Group 2019-2020[65.26%(124/190)vs 75.09%(214/285),14.21%(27/190)vs 30.18%(86/285),6.32%(12/190)vs 15.09%(43/285),16.84%(32/190)vs 25.61%(73/285)],with statistically significant differences(χ^(2) were 5.361,16.026,8.568 and 5.094 respectively,all P<0.05).The positive rate of rhinovirus in the Group 2020-2021 was higher than that in the Group 2019-2020[13.16%(25/190)vs 4.91%(14/285)]and the difference was statistically significant(χ^(2)=10.285,P<0.05).There were no significant differences in the positive rates of human metapneumovirus,Boca virus and parainfluenza virus 3 between the two groups(all P>0.05).Conclusion The clinical characteristics and etiology of patients with bronchiolitis have changed after the COVID-19 pandemic.The quarantine and protection measures reduce the transmission of associated pathogens and the severity of the disease.