2020~2021年绵阳市百日咳患儿临床特征及影响因素探讨

Clinical Characteristics and Influencing Factors of Pertussis Children in Mianyang City from 2020 to 2021

目的探讨绵阳市百日咳患儿临床特征及影响因素。方法回顾性分析绵阳市妇幼保健院2020年1月至2021年12月住院确诊的51例百日咳患儿流行病学及临床资料,比较不同年龄、不同病程及不同免疫状态患儿血常规参数特征。结果①51例患儿,男20例,女31例,≤3月龄8例(15.6%),3~12月龄16例(31.4%),>12~36月龄6例(11.8%),>36月龄21例(41.2%);全年均可发病,春夏高发;12例(23.5%)存在疑似接触史;完全免疫组29例(56.9%),不全免疫组22例(42.3%)。②入院时病程中位时间为15 d,其中<14 d 23例(45.1%),14~30 d 17例(33.3%),≥30 d 11例(21.6%);主要临床表现为阵发性痉挛性咳嗽伴咳后呕吐31例(60.8%)、肺部无阳性体征34例(66.7%);单纯感染35例(68.6%),混合感染例16例(31.4%),混合感染病原以肺炎支原体为主;18例(35.3%)有并发症,肺炎为主;③比较不同病程、年龄段、免疫状态血常规参数,白细胞计数(WBC)在完全免疫组、病程≥30 d、>36月龄组均基本正常或稍升高,不同免疫组差异有统计学意义(P<0.05);淋巴细胞比率(L)各组差异均有统计学意义(P<0.05),随着病程延长、发病年龄增长其值逐渐降低,不全免疫组显著升高(P<0.001);血小板计数(PLT)随着病程延长逐渐降低、>36月龄及完全免疫组PLT基本正常,不同年龄组及免疫组显著差异(P<0.001)。结论百日咳多发生于≤12月龄及未完成基础免疫的婴儿,>36月龄且完成全程免疫年长儿亦占较高比例,探索及调整百日咳疫苗免疫策略尤为迫切;临床症状趋于不典型,易出现混合感染,病程早期、未完成基础免疫患儿WBC、L、PLT显著升高,>36月龄患儿WBC、L、PLT基本正常,百日咳杆菌核酸检测及外周血常规有助于早期诊断。

Objective To investigate the clinical characteristics and influencing factors of pertussis children in Mianyang City,Sichuan Province.Methods The epidemiological and clinical data of 51 children with pertussis diagnosed in Mianyang Maternal and Child Health Hospital from January 2020 to December 2021 was retrospectively analyzed.The blood routine parameters of children with different ages,disease course and immune status were compared.Results①Among 51 children,20 were male and 31 were female,8(15.6%)were≤3 months old,16(31.4%)were 3~12 months old,6(11.8%)were>12~36 months old,and 21(41.2%)were>36 months old.The disease was found to occur throughout the year,with a high incidence in spring and summer.Twelve cases(23.5%)had suspected contact history.There were 29 cases(56.9%)in the complete immune group and 22 cases(42.3%)in the incomplete immune group.②The median duration of disease at admission was 15 days,of which 23 cases(45.1%)were<14 days,17 cases(33.3%)were 14~30 days,and 11 cases(21.6%)were≥30 days.The main clinical manifestations were paroxysmal spastic cough with postcough vomiting in 31 cases(60.8%)and no positive pulmonary signs in 34 cases(66.7%).There were 35 cases(68.6%)of simple infection and 16 cases(31.4%)of mixed infection.Mycoplasma pneumoniae was the main pathogen of mixed infection.18 cases(35.3%)had complications,mainly pneumonia.③The blood routine parameters of different course of disease,age,and immune status were compared.The white blood cell count(WBC)was basically normal or slightly increased in the fully immunized group,the course of disease≥30 days,and the>36 months group,and the difference was statistically significant(P<0.05).Lymphocyte proportion(L)was significantly different among all groups(P<0.05),and was decreased with the prolongation of disease duration and age of onset,while was increased significantly in the incomplete immune group(P<0.001).Platelet count(PLT)dropped gradually with the prolongation of disease course,PLT was basically normal in the group>36 months old and fully immunized,and there were significant differences between different age groups and immunized groups(P<0.001).Conclusion Pertussis is more common in infants aged less than 12 months and infants who have not developed primary immunization.Older infants aged more than 36 months and infants who have completed full immunization also account for a high proportion.It is particularly urgent to explore and adjust the immunization strategy of pertussis vaccine.The clinical symptoms tend to be atypical,and mixed infection is easy to occur.WBC,L and PLT are significantly increased in children with early course of disease and incomplete primary immunization,and the WBC,L and PLT are basically normal in children older than 36 months.