儿童毛细支气管炎后反复喘息的危险因素分析

Risk Factors for Recurrent Wheezing after Bronchiolitis in Children.

目的研究毛细支气管炎患儿出院1年后反复喘息的发生情况及危险因素,并比较呼吸道合胞病毒(respiratory syncy-tial virus,RSV)和人鼻病毒(human rhinovirus,HRV)感染患儿的反复喘息发生率。方法收集2018年1~12月温州医科大学附属第二医院育英儿童医院收治的932例因毛细支气管炎住院患儿的鼻咽部分泌物,采用聚合酶链反应-毛细电泳片段分析法(polymerase chain reaction-capillary electrophoresis fragment analysis,PCR-CEFA)检测呼吸道病毒核酸。出院后随访1年,比较反复喘息组与非反复喘息组的临床资料,以及RSV、HRV感染患儿反复喘息发生率。结果共检出981株病毒,以HRV 333株(33.9%)和RSV 319株(32.5%)最常见。随访成功435例,随访1年时有130例患儿(29.9%)发生反复喘息,其中,HRV组的反复喘息发生率明显高于RSV组(37.7%vs 25.5%,χ2=5.504,P=0.019)。反复喘息组中男性、既往喘息史、哮喘家族史、家族过敏性疾病史、HRV感染比例均高于非反复喘息组(χ2分别为13.715、12.913、6.795、5.706、4.664,P<0.05)。结论RSV、HRV是毛细支气管炎患儿的主要病原体;HRV感染后反复喘息发生率高于RSV感染;男性、既往喘息病史、哮喘家族史、HRV感染为毛细支气管炎患儿发生反复喘息的危险因素。

Objective To study the occurrence and risk factors of recurrent wheezing in children with bronchiolitis 1 year after discharge from the hospital,and to compare the incidence of recurrent wheezing in children with respiratory syncy-tial virus(RSV)and human rhinovirus(HRV)infections.Methods The nasopharyngeal secretions of 932 children with bronchiolitis hospitalized in the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University from January to December 2018 were collected,and the respiratory virus nucleic acid was detected by polymerase chain reaction-capillary electrophoresis fragment analysis(PCR-CEFA).Follow-up to 1 year after discharge,compare the clinical data of recurrent wheezing group and non-recurrent wheezing group,and the incidence of recurrent wheezing in children with RSV and HRV infection.Results A total of 981strains of viruses were detected,333(33.9%)strains of HRV and 319(32.5%)strains of RSV were the most common.435 cases were followed up successfully.Followed up for 1 year,130 children(29.9%)had repeated wheezing.Among them,the probability of recurrent wheezing in the HRV group was significantly higher than that in the RSV group(37.7%vs 25.5%,χ2=5.504,P=0.019).The proportions of male children,previous wheezing history,family history of asthma,family history of allergic diseases,and HRV infection in the recurrent wheezing group were all higher than those in the non-recurrent wheezing group(χ2 were 13.715,12.913,6.795,5.706,4.664,P<0.05).Conclusion RSV and HRV are the main pathogens in children with bronchiolitis.The incidence of recurrent wheezing after HRV infection was higher than that of RSV infection.Male,previous history of wheezing,family history of asthma,and HRV infection are the risk factors for recurrent wheezing in children with bronchiolitis.