新生儿重症肠道病毒感染临床特征分析

Clinical features of neonatal severe enterovirus infection

目的分析新生儿重症肠道病毒感染的临床特点和影响因素。方法回顾性分析2019年12月—2020年12月昆明医科大学附属儿童医院收治的76例新生儿肠道病毒感染患儿资料,根据感染严重程度分为普通感染组(63例)和重症感染组(13例)。比较2组患儿临床特征,并采用logistic回归分析研究发生重症肠道病毒感染的危险因素。结果与普通感染组患儿相比,重症感染组患儿出生胎龄小、早产儿比例高、起病时间更早,差异有统计学意义(均P<0.05);重症感染组患儿白细胞计数异常(<5×10^(9)/L或>15×10^(9)/L)、血小板减低、pH下降、C反应蛋白升高、降钙素原及乳酸升高的发生率高于普通感染组(均P<0.05),合并肝功能异常、凝血功能异常、心肌损伤的发生率也高于普通感染组(均P<0.05);重症感染组患儿死亡率高于普通感染组(P<0.05);多因素logistic回归分析显示,早产(OR=7.125,95%CI:2.275~29.021)、凝血功能异常(OR=22.452,95%CI:2.948~268.656)及pH≤7.25(OR=14.569,95%CI:2.675~40.590)是发生重症肠道病毒感染的独立危险因素。结论普通感染和重症感染的新生儿肠道病毒感染患儿临床表现、合并症及实验室检查均存在差异。肠道病毒感染的新生儿如果存在早产、起病时间早、酸中毒、乳酸升高、肝功能异常、凝血功能异常等需警惕重症感染。

Objective To analyze the clinical characteristics and influencing factors of neonatal severe enterovirus infection.Methods A retrospective analysis of neonatal enterovirus infection cases admitted to Children's Hospital Affiliated of Kunming Medical University from December 2019 to December 2020 was performed.Based on the severity of infection,they were divided into the common infection group(n=63)and severe infection group(n=13).The clinical characteristics of the two groups were compared,and the risk factors of severe enterovirus infection were analysed by Logistic regression.Results Compared with the common infection group,the severe infection group had a significantly lower gestational age at birth and a significantly higher proportion of preterm infants and a significantly earlier onset time(P<0.05).The abnormal white blood cells(<5×10^(9)/L or>15×10^(9)/L),thrombocytopenia,pH decrease,C-reactive protein increase,procalcitonin and lactic acid increase were higher than those in the common infection group(all P<0.05).The incidence of combined liver function abnormality,coagulation function abnormality and myocardial injury was also higher than that of common infection group(all P<0.05).The mortality of children in severe infection group was higher than that in common infection group(P<0.05).Multivariate logistic regression analysis showed that preterm birth(OR=7.125,95%CI:2.275-29.021),coagulation dysfunction(OR=22.452,95%CI:2.948-268.656)and pH≤7.25(OR=14.569,95%CI:2.675-40.590)were the risk factors for severe enterovirus infection.Conclusion Significant differences in clinical manifestations,complications and laboratory tests are observed between the neonates with common and severe enterovirus infection.Neonatal enterovirus infection is accompanied by premature delivery,early onset,acidosis,elevated lactic acid,abnormal liver function,and abnormal blood coagulation function,and it is necessary to be alert to severe infection.