儿童百日咳住院病例248例临床特征及重症百日咳相关危险因素分析

Clinical features of pertussis in 248 hospitalized children and risk factors of severe pertussis

目的探讨儿童百日咳的临床特点,分析重症百日咳的相关危险因素。方法采用回顾性研究的方法对2018年3月至2022年3月湖南省儿童医院248例百日咳住院患儿的临床资料进行分析。根据入院时年龄分为≤3个月组,>3个月组;根据百日咳病情分为普通组及重症组,根据是否混合其他病原菌感染分为单纯感染组及混合感染组。采用独立样本t检验、χ^(2)检验比较组间临床指标的差异。结果1.住院百日咳患儿以<1岁患儿为主(204/248,82.2%),有咳嗽家属接触史92例(37.0%),未接种疫苗169例(68.1%);248例患儿中白细胞数增高193例(77.8%);145例(58.4%)患儿存在混合感染,最常见的病原为呼吸道合胞病毒(29例,11.6%);并发肺炎173例(69.7%),并发肺实变35例(14.1%)。2.≤3个月组患儿咳嗽患者接触史、发绀、呼吸困难、呼吸衰竭、心力衰竭、百日咳脑病、重症监护室(ICU)住院、机械通气比例均高于>3个月组(χ^(2)=4.612、20.810、7.882、16.617、13.740、7.846、14.810、21.436,均P<0.05),死亡率高于>3个月组(χ^(2)=12.016,P<0.05);≤3个月组患儿白细胞(WBC)高于>3个月组[(27.83±27.70)×10^(9)/L比(23.34±15.28)×10^(9)/L,t=22.244,P<0.001],痉挛性咳嗽时间长于>3个月组[(16.56±9.33)d比(15.06±6.16)d,t=10.145,P=0.002]、住院时间长于>3个月组[(11.47±10.48)d比(9.48±4.80)d,t=20.050、P<0.001]。3.与普通百日咳组比较,重症百日咳组患儿≤3个月、未接种百日咳疫苗、呼吸困难、淋巴细胞计数(LC)/中性粒细胞计数(NC)比值<1、混合感染、肺实变及胸腔积液患儿的比例较高(χ^(2)=14.803、4.475、116.940、43.625、13.253、106.370、11.874,均P<0.05),WBC高于普通百日咳组[(61.66±29.63)×10^(9)/L比(18.83±10.00)×10^(9)/L,t=112.580,P<0.001],LC比例低于普通百日咳组(0.494±0.186比0.676±0.132,t=13.752,P<0.001)。4.与单纯感染组比较,混合感染组患儿发热、呼吸困难、肺部细湿啰音、LC/NC比值<1、肺实变、ICU住院治疗、机械通气、呼吸衰竭、死亡的比例均高于单纯感染组(χ^(2)=8.909、6.804、7.563、8.420、12.458、11.677、7.397、7.980、4.267,均P<0.05),WBC高于单纯感染组[(27.73±24.13)×10^(9)/L比(21.25±14.65)×10^(9)/L,t=13.318,P<0.001],住院天数长于单纯感染组[(11.593±9.010)d比(8.339±4.047)d,t=17.283,P<0.001],但LC比值低于单纯感染组(0.626±0.165比0.684±0.132,t=7.997,P=0.005)。5.Logistic回归分析显示年龄≤3个月、WBC峰值以及呼吸困难为重症百日咳的相关危险因素。结论住院患儿百日咳发生肺炎、肺实变的比例高,年龄≤3个月、高WBC以及存在呼吸困难患儿易发展为重症,监测血常规有助于病情严重程度的判断,混合其他病原感染并发症发生率更高,且可影响治疗疗效。

Objective To investigate the clinical features of pertussis in children and analyze the risk factors of severe pertussis.Methods The clinical data of 248 children with pertussis hospitalized in Hunan Children′s Hospital from March 2018 to March 2022 were analyzed retrospectively.According to the age at admission,the patients were divided into two groups:≤3 months and>3 months.According to the patient′s condition,they were classified into ordinary group and severe group.According to the pathogens detected,the children were divided into single infection group and mixed infection group.The independent sample t-test,chi-square test were used to analyze the clinical indexes of the infants in above groups.Results(1)Of 248 hospitalized children with pertussis,204 cases(82.2%)were less than 1 year old,92 cases(37.0%)had contact with a coughing family member before,and 169 cases(68.1%)were unvaccinated.Among 248 children,193 cases(77.8%)had an elevated white blood cell count,and 145 cases(58.4%)had mixed infections.The most common pathogen was respiratory syncytial virus[29/248(11.6%)].About 173 cases(69.7%)had concurrent pneumonia,and 35 cases(14.1%)had pulmonary consolidation.(2)Compared with the group>3 months of age,more patients in the group≤3 months of age had contact with a coughing family member before,and suffered from cyanosis,dyspnea,respiratory failure,heart failure and pertussis encephalopathy(χ^(2)=4.612,20.810,7.882,16.617,13.740,7.846,all P<0.05).The proportions of patients in the group≤3 months of age required intensive care unit(ICU)hospitalization and mechanical ventilation were higher than those in the group>3 months of age(χ^(2)=14.810,21.436,all P<0.05).The mortality of the group≤3 months of age was higher than that of the group>3 months of age(χ^(2)=12.016,P<0.05).Children≤3 months of age had a higher WBC level[(27.83±27.70)×10^(9)/L vs.(23.34±15.28)×10^(9)/L,t=22.244,P<0.001],longer duration of spasmodic cough[(16.56±9.33)d vs.(15.06±6.16)d,t=10.145,P=0.002]and longer hospitalization time[(11.47±10.48)d vs.(9.48±4.80)d,t=20.050,P<0.001]than those>3 months of age.(3)Compared with the ordinary group,a higher proportion of children in the severe pertussis group were under 3 months old,and had not been vaccinated against pertussis vaccine(χ^(2)=14.803,4.475,all P<0.05).The ratio of patients with dyspnea,an lymphocyte count/neutral cell(LC/NC)ratio<1,mixed infections,lung consolidation and pleural effusion in the severe pertussis group was higher than that in the ordinary group(χ^(2)=116.940,43.625,13.253,106.370,11.874,all P<0.05).The patients in the severe pertussis group had a higher WBC[(61.66±29.63)×10^(9)/L vs.(18.83±10.00)×10^(9)/L,t=112.580,P<0.001]and a lower LC(0.494±0.186 vs.0.676±0.132,t=13.752,P<0.001)than those in the ordinary group.(4)Compared with the single infection group,the proportions of children with fever,dyspnea,fine moist lung rales,an LC/NC ratio<1,and lung consolidation were higher in the mixed infection group(χ^(2)=8.909,6.804,7.563,8.420,12.458,all P<0.05).More children in the mixed infection group required ICU hospitalization and mechanical ventilation than those in the single infection group(χ^(2)=11.677,7.397,all P<0.05).The mixed infection group had higher respiratory failure and death rates than the single infection group(χ^(2)=7.980,4.267,all P<0.05).Compared with the single infection group,the mixed infection group had a higher WBC level[(27.73±24.13)×10^(9)/L vs.(21.25±14.65)×10^(9)/L,t=13.318,P<0.001],longer hospitalization time[(11.593±9.010)d vs.(8.339±4.047)d,t=17.283,P<0.001],and a smaller LC ratio(0.626±0.165 vs.0.684±0.132,t=7.997,P=0.005).(5)Logistic regression analysis showed that age≤3 months,peak WBC and dyspnea were risk factors of severe pertussis.Conclusions Hospitalized pertussis children are prone to pneumonia and pulmonary consolidation.Patients aged≤3 months with a large WBC and dyspnea easily develop into severe pertussis.Monitoring blood routine is helpful for judging the severity of the disease.Mixed infections increase the incidence of complications and can impair the treatment effect.