新型冠状病毒感染疫情对毛细支气管炎患儿住院影响的临床多中心研究

A multicenter clinical study of the impact of COVID-19 pandemic on hospitalization of children with bronchiolitis

目的探讨新型冠状病毒感染(corona virus disease 2019,COVID-19)疫情对毛细支气管炎患儿住院的影响,以提高临床医生对于COVID-19流行期间毛细支气管炎特点的认识。方法该研究为多中心临床研究,病例资料来自全国23个儿童研究中心。回顾性收集2019年1月1日至2021年12月31日在各研究中心住院治疗的毛细支气管炎患儿的临床资料,包括性别、住院时月龄、住院天数、呼吸道合胞病毒(respiratory syncytial virus,RSV)检测结果、病情严重分度、是否住ICU治疗以及同期呼吸道感染住院患儿总数。对COVID-19流行前的2019年和流行期间的2020、2021年的毛细支气管炎患儿临床资料进行统计分析比较。结果根据23个儿童研究中心提供的数据汇总,2019年毛细支气管炎病例共4909例,2020年共2654例,2021年共3500例。与2019年相比,2020年和2021年毛细支气管炎病例数量分别下降了45.94%和28.70%。2019年、2020年和2021年患儿性别比例、住院时月龄、住院天数差异无统计学意义。与2019年相比,2020年和2021年毛细支气管炎占呼吸道感染住院总人数的比率均显著下降(χ^(2)=12.762,P<0.05;χ^(2)=84.845,P<0.05)。2020年和2021年中/重度毛细支气管炎的比例均低于2019年,差异有统计学意义(χ^(2)=4.054,P<0.05;χ^(2)=8.109,P<0.05)。2019年、2020年和2021年入ICU治疗的毛细支气管炎患儿比例差异无统计学意义(χ^(2)=1.914,P>0.05)。2019年共有52.60%(2582/4909)毛细支气管炎患儿进行RSV病原检测,其中RSV阳性708例,阳性占比为28.00%;2020年有54.14%(1437/2654)的毛细支气管炎患儿进行RSV病原检测,RSV阳性403例,阳性占比为28.04%;2021年有66.80%(2238/3500)的毛细支气管炎患儿进行RSV病原检测,RSV阳性935例,阳性占比为41.78%。与2019年和2020年相比,2021年RSV检出阳性率显著升高(χ^(2)=99.673,P<0.05;χ^(2)=71.292,P<0.05)。结论在COVID-19疫情期间,疫情防控措施降低了毛细支气管炎患儿的住院率和严重程度,但未降低住院毛细支气管炎患儿的RSV检出阳性率。

ObjectiveIn order to explore the impact of corona virus disease 2019(COVID-19)on the hospitalization of children with bronchiolitis and to improve clinicians′understanding of the characteristics of bronchiolitis during the COVID-19 epidemic.MethodsThis was a multicenter clinical study,and the data have been collected from 23 children′s medical centers in China.All the clinical data were retrospectively collected from children with bronchiolitis who were hospitalized at each study center from January 1,2019 to December 31,2021.The results included gender,age at hospitalization,length of stay,respiratory syncytial virus(RSV)test results,severity rating,ICU treatment,and the total number of children hospitalized with respiratory tract infection during the same period.The clinical data of children with bronchiolitis in 2019 before COVID-19 epidemic and in 2020、2021 during COVID-19 epidemic were statistically analyzed and compared.ResultsAccording to a summary of data provided by 23 children′s medical centers,there were 4909 cases of bronchiolitis in 2019,2654 cases in 2020,and 3500 cases in 2021.Compared with 2019,the number of bronchiolitis cases decreased by 45.94%in 2020 and 28.70%in 2021.In 2019,2020 and 2021,there were no significant differences in gender ratio,age,and duration of hospitalization.Compared with 2019,the ratio of bronchiolitis to the total number of hospitalizations for respiratory tract infection decreased significantly in 2020 and 2021(χ^(2)=12.762,P<0.05;χ^(2)=84.845,P<0.05).The proportion of moderate to severe bronchiolitis cases in both 2020 and 2021 was lower than that in 2019,and the difference was statistically significant(χ^(2)=4.054,P<0.05;χ^(2)=8.109,P<0.05).There was no statistically significant difference in the proportion of bronchiolitis cases requiring ICU treatment between 2019,2020,and 2021(χ^(2)=1.914,P>0.05).In 2019,a total of 52.60%(2582/4909)of children with bronchiolitis underwent RSV pathogen testing,and among them,there were 708 cases with RSV positive,accounting for 28.00%.In 2020,54.14%(1437/2654)of children with bronchiolitis underwent RSV pathogen testing,and there were 403 cases with RSV positive,accounting for 28.04%.In 2021,66.80%(2238/3500)of children with bronchiolitis underwent RSV pathogen testing,and there were 935 cases with RSV positive,accounting for 41.78%.Compared with 2019 and 2020,the RSV positive rate in 2021 showed a significant increase(χ^(2)=99.673,P<0.05;χ^(2)=71.292,P<0.05).ConclusionDuring the COVID-19 epidemic,the implementation of epidemic prevention and control measures reduced the hospitalization rate and severity of bronchiolitis,but did not reduce the positive rate of RSV detection.