SARS‑CoV‑2感染儿童的临床特征分析

Clinical characteristics of children with SARS‑CoV‑2 infection

目的:分析SARS⁃CoV⁃2感染儿童的临床特征,并探讨重型患儿的相关危险因素。方法:连续纳入自2022年12月—2023年1月COVID⁃19疫情防控政策放开以来入住武汉大学人民医院东院儿科的SARS⁃CoV⁃2核酸检测呈阳性的患儿,并详细收集其临床及实验室检查资料,采用SPSS软件进行统计学分析。结果:共纳入129例SARS⁃CoV⁃2感染患儿,男/女:91/38(χ^(2)=21.775,P<0.001),年龄:1.58(0.62,4.37)岁,轻型50例(38.8%),普通型16例(12.4%),重型63例(48.8%)。与非重型者(轻型+普通型)相比,重型者患儿年龄更大(P=0.017);在临床症状方面,重型者惊厥(P<0.001)、呼吸困难(P=0.009)的发生率高,咳嗽(P=0.004)、流涕鼻塞(P=0.018)、呕吐(P=0.020)的发生率更低,而两者在发热、腹痛、腹泻、声嘶、皮疹方面差异无统计学意义(P>0.05);在实验室指标方面,ALT升高的发生率更低(P<0.001),淋巴细胞减少的发生率更高(P=0.041),淋巴细胞计数更低(P=0.017),中性粒细胞/淋巴细胞比例(NLR)更高(P=0.001),而两者在WBC计数、CRP、PCT、心肌酶方面差异无统计学意义(P>0.05)。二元Logistic回归分析结果显示淋巴细胞减少(OR=2.546,95%CI:1.064~6.901)与重型相关。受试者工作特征曲线(ROC)分析结果显示淋巴细胞计数可用于预测重型,其曲线下面积(AUC)为0.604,预测敏感度为68.3%,特异度为59.1%。结论:SARS⁃CoV⁃2感染的住院患儿以婴幼儿为主,男孩多于女孩,重型者年龄较非重型者大,更常见淋巴细胞减少及NLR升高。淋巴细胞减少是重型的独立危险因素,可用于预测重型。

Objective:To analyze the clinical features of children with severe acute respiratory syndrome coronavirus 2(SARS⁃CoV⁃2)infection and to explore the risk factors for severe cases.Methods:Chil⁃dren with positive SARS⁃CoV⁃2 nucleic acid test who were admitted to the Department of Pediatrics,East Hospital of Renmin Hospital of Wuhan University from December 2022 to January 2023 were consecutively enrolled.Detailed clinical and laboratory data were collected.Results:A total of 129 children with SARS⁃CoV⁃2 infection were enrolled,with a male/female ratio of 91/38(χ^(2)=21.775,P<0.001)and an median age of 1.58(0.62,4.37)years.There were 50 mild cases(38.8%),16 common cases(12.4%),and 63 severe cases(48.8%).Compared with the non⁃severe group(mild+common),the severe group was older(P=0.017).In terms of clinical symptoms,the severe group had a higher incidence of convulsion(P<0.001)and dyspnea(P=0.009),and a lower incidence of cough(P=0.004),runny nose(P=0.018)and vomiting(P=0.020),while there was no significant difference in fever,abdominal pain,diarrhea,hoarseness,and rash between the two groups(P>0.05).In terms of laboratory indicators,the incidence of ALT elevation was lower(P<0.001),the in⁃cidence of lymphopenia was higher(P=0.041),the lymphocyte count was lower(P=0.017),and the neutrophil⁃to⁃lymphocyte ratio(NLR)was higher(P=0.001).There were no significant differences in WBC count,CRP,PCT,and myocardial enzymes between the two groups(P>0.05).Binary logis⁃tic regression analysis showed that lymphopenia(OR=2.546,95%CI:1.064⁃6.901)was associated with severe disease.Receiver operating characteristic curve(ROC)analysis showed that lymphocyte count could be used to predict severe disease,with an area under the curve(AUC)of 0.604,a sensi⁃tivity of 68.3%,and a specificity of 59.1%.Conclusion:Most of the hospitalized children with SARS⁃CoV⁃2 infection are infants and younger children,and there are more boys than girls.Patients with severe SARS⁃CoV⁃2 infection are older,and have a higher incidence of lymphopenia and an in⁃creased NLR than those with non⁃severe SARS⁃CoV⁃2 infection.Lymphopenia is an independent risk factor for severe disease and can be used to predict severe disease.