昆明地区新型冠状病毒Omicron变异株感染患儿的临床特征

Clinical characteristics of children with SARS-CoV-2 Omicron variant infection in Kunming

目的了解新型冠状病毒疫情非药物性干预措施解除后,昆明地区新型冠状病毒Omicron变异株感染住院患儿的临床特点及重症患儿的危险因素分析。方法回顾性病例总结,分析2022年12月10日至2023年1月9日昆明市6家三甲医院1145例新型冠状病毒Omicron变异株感染的住院患儿的临床资料,根据临床严重程度将患儿分为普通组和重症组,比较两组患儿的临床及实验室资料。采用t检验、χ^(2)检验和Mann-Whitney U检验进行组间比较,采用Spearman相关性检验和多因素Logistic回归方法分析重症组的危险因素。结果1145例患儿中男677例、女468例,就诊年龄1.7(0.5,4.1)岁,≤3岁758例(66.2%),>3岁387例(33.8%)。有基础疾病89例(7.8%)、无基础疾病1056例(92.2%)。接种疫苗者(≥1剂)319例(27.9%),急性上呼吸道感染748例(65.3%),死亡6例(0.5%)。普通组1051例、重症组94例。重症组的接种疫苗的比例、就诊年龄、淋巴细胞计数和CD8+淋巴细胞比例均低于普通组[36例(38.3%)比283例(26.9%)、0.5(2.6,8.0)比1.6(0.5,3.9)岁、1.3(1.0,2.7)×109比2.7(1.3,4.4)×109/L、0.17(0.12,0.24)比0.21(0.15,0.16),χ^(2)=4.88、Z=-2.21、-5.03、-2.53,均P<0.05]。重症组的住院时间、有基础病的比例、丙氨酸转氨酶、天冬氨酸转氨酶、肌酸激酶同工酶、肌钙蛋白T水平均高于普通型组[(11.6±5.9)比(5.3±1.8)d、41例(43.6%)比48例(4.6%)、67(26,120)比20(15,32)U/L、51(33,123)比44(34,58)U/L、56.9(23.0,219.3)比3.6(1.9,17.9)U/L、12.0(4.9,56.5)×10^(-3)比3.0(3.0,7.0)×10^(-3)pg/L,t=-20.43,χ^(2)=183.52,Z=-9.14、-3.12、-6.38、-3.81,均P<0.05]。多因素Logistic回归分析示白细胞计数(OR=1.88,95%CI 1.18~2.97,P<0.01)、C反应蛋白(OR=1.18,95%CI 1.06~1.31,P<0.01)、铁蛋白(OR=1.01,95%CI 1.00~1.00,P<0.01)、白细胞介素6(OR=1.05,95%CI 1.01~1.08,P=0.012)、D二聚体(OR=2.56,95%CI 1.44~4.56,P<0.01)升高,CD4+淋巴细胞比例降低(OR=0.84,95%CI 0.73~0.98,P=0.030)均是住院患儿发生重症的危险因素。结论新型冠状病毒疫情非药物性干预措施解除后,昆明地区Omicron变异株感染的住院患儿以≤3岁的患儿为主,主要表现为上呼吸道感染,重症比例及病死率较低。白细胞计数、C反应蛋白、铁蛋白、白细胞介素6、D二聚体升高,CD4+淋巴细胞比例降低是发生重症的高危因素。

ObjectiveTo investigate the clinical characteristics of hospitalized children infected with the Omicron variant in Kunming after the withdrawal of non-pharmaceutical interventions(NPI)and analyze the risk factors of severe cases.MethodsClinical data was retrospectively collected from 1145 children with SARS-CoV-2 Omicron infection who were hospitalized in six tertiary grade A hospitals in Kunming from December 10th,2022 to January 9th,2023.According to clinical severity,these patients were divided into the general and severe SARS-CoV-2 groups,and their clinical and laboratory data were compared.Between-group comparison was performed using t-test,chi-square test and Mann-Whitney U test.Spearman correlation test and multivariate Logistic regression analysis were used to determine the risk factors of severe illness.ResultsA total of 1145 hospitalized patients were included,of whom 677 were male and 468 female.The age of these patients at visit was 1.7(0.5,4.1)years.Specifically,there were 758 patients(66.2%)aged≤3 years at visit and 387 patients(33.8%)aged>3 years.Of these children,89 cases(7.8%)had underline diseases and the remaining 1056 cases(92.2%)had no combined diseases.Additionally,of all the patients,319 cases(27.9%)were vaccinated with one or two doses of SARS-CoV-2 vaccine,748 cases(65.3%)had acute upper respiratory tract infection(AURTI),and six cases died(0.5%).A total of 1051 cases(91.8%)were grouped into general SARS-CoV-2 group and 94 cases(8.2%)were grouped into severe SARS-CoV-2 group.Compared with the general cases,the severe cases showed a lower rate of SARS-CoV-2 vaccination and younger median age,lower lymphocyte count,as well as proportions of CD8+T lymphocyte(36 cases(38.3%)vs.283 cases(26.9%),0.5(2.6,8.0)vs.1.6(0.5,3.9)years,1.3(1.0,2.7)×109 vs.2.7(1.3,4.4)×109/L,0.17(0.12,0.24)vs.0.21(0.15,0.16),respectively,χ^(2)=4.88,Z=-2.21,-5.03,-2.53,all P<0.05).On the other hand,the length of hospital stay,proportion of underline diseases,ALT,AST,creatine kinase isoenzyme,and troponin T were higher in the severe group compared to those in the general group((11.6±5.9)vs.(5.3±1.8)d,41 cases(43.6%)vs.48 cases(4.6%),67(26,120)vs.20(15,32)U/L,51(33,123)vs.44(34,58)U/L、56.9(23.0,219.3)vs.3.6(1.9,17.9)U/L,12.0(4.9,56.5)vs.3.0(3.0,7.0)×10^(-3)pg/L,respectively,t=-20.43,χ^(2)=183.52,Z=-9.14,-3.12,-6.38,-3.81,all P<0.05).Multivariate regression analysis indicated that increased leukocyte count(OR=1.88,95%CI 1.18-2.97,P<0.01),CRP(OR=1.18,95%CI 1.06-1.31,P<0.01),ferritin(OR=1.01,95%CI 1.00-1.00,P<0.01),interleukin(IL)-6(OR=1.05,95%CI 1.01-1.08,P=0.012),D-dimer(OR=2.56,95%CI 1.44-4.56,P<0.01)and decreased CD4+T lymphocyte(OR=0.84,95%CI 0.73-0.98,P=0.030)were independently associated with the risk of severe SARS-CoV-2 in hospitalized children with Omicron infection.ConclusionsAfter the withdrawal of NPI,the pediatric inpatients with Omicron infection in Kunming were predominantly children younger than 3 years of age,and mainly manifested as AURTI with relatively low rate of severe SARS-CoV-2 infection and mortality.Elevated leukocyte counts,CRP,ferritin,IL-6,D-dimer,and decreased CD4+T lymphocytes are significant risk factors for developing severe SARS-CoV-2 infection.