165例住院儿童甲型流感病毒肺炎及混合感染的临床特征

Clinical characteristics of 165 hospitalized children with influenza A virus pneumonia and mixed infection

目的分析儿童甲型流感病毒肺炎感染及混合感染的临床特征。方法回顾性分析2019年12月至2021年12月在苏州大学附属儿童医院住院的165例儿童甲型流感病毒肺炎的临床资料,根据是否混合其它病原菌分为混合感染组(111例)和非混合感染组(54例)。结果儿童甲型流感病毒肺炎呈季节性流行,冬春季节多见。主要临床表现为发热、咳嗽、消化道等症状。混合感染组消化道症状多于非混合感染组(P<0.05),两组性别、年龄、高热、咳嗽、呼吸困难、惊厥及合并其它呼吸系统、神经系统、循环系统、多器官功能损害、电解质紊乱、中耳炎并发症差异无统计学意义。非混合感染组发生白细胞降低多于混合感染组,C-反应蛋白、乳酸脱氢酶升高者混合感染组多于非混合感染组(P均<0.05)。165例儿童混合感染率67.27%,检出细菌阳性率44.24%(肺炎链球菌及流感嗜血杆菌多见),其次为肺炎支原体、病毒。经治疗96.36%患儿痊愈出院,并发严重并发症的6例儿童均混合其它病原菌感染,其中4例有基础疾病。混合感染组住院时间长于非混合感染组,住院费用高于非混合感染组(P均<0.05)。结论儿童甲型流感病毒肺炎易混合多种病原菌感染,增加家庭及社会负担,临床工作中需警惕混合感染,及时诊断及治疗,提高早期治愈率。

Objective To analyze the clinical characteristics of influenza A virus pneumonia infection and mixed infection in children.Methods The clinical data of 165 children with influenza A virus pneumonia who were hospitalized in the Children′s Hospital of Soochow University from December 2019 to December 2021 were retrospectively analyzed.According to whether they were mixed with other pathogens,they were divided into the mixed infection group(111 cases)and the non-mixed infection group(54 cases).Results Influenza A virus pneumonia in children was seasonally prevalent,more common in winter and spring.The main clinical manifestations were fever,cough,and gastrointestinal symptoms.Gastrointestinal symptoms in the mixed infection group were more than those in the non-mixed infection group(P<0.05).There were no significant differences in gender,age,high fever,cough,dyspnea,convulsions,and other complications of respiratory system,nervous system,circulatory system,multiple organ dysfunction,electrolyte imbalance,and otitis media between the two groups.The incidence of leukopenia in the non-mixed infection group was higher than that in the mixed infection group,and the increase of C-reactive protein and lactate dehydrogenase in the mixed infection group was more than that in the non-mixed infection group(all P<0.05).The mixed infection rate of 165 children was 67.27%,and the positive rate of bacteria was 44.24%(Streptococcus pneumoniae and Haemophilus influenzae were more common),followed by Mycoplasma pneumoniae and virus.After treatment,96.36%of the children were cured and discharged.The 6 children with severe complications were all mixed with other pathogenic bacteria,and 4 of them had underlying diseases.The duration of hospital stay in the mixed infection group was longer than that in the non-mixed infection group,and the hospitalization cost was higher than that in the non-mixed infection group(all P<0.05).Conclusion Influenza A virus pneumonia in children is easy to be mixed with a variety of pathogenic bacteria,which increases the burden on families and society.In clinical work,it is necessary to be vigilant about mixed infection and timely diagnosis and treatment to improve the early cure rate.