2~5岁儿童呼吸道合胞病毒性肺炎的临床特点研究

Clinical characteristics of respiratory syncytial viral pneumonia in children aged 2 to 5 years

目的探讨2~5岁儿童呼吸道合胞病毒(respiratory syncytial virus, RSV)肺炎的临床特点及引起重症肺炎的危险因素, 为其早诊断提供理论依据。方法回顾分析2017年12月至2023年6月北京新世纪儿童医院收治的210例2~5岁RSV肺炎儿童的临床资料, 按照病情轻重分为轻度组和重度组, 比较其一般资料和临床特点, 并分析重症RSV肺炎的危险因素。结果在210例RSV感染患儿中, 男女比为1.26∶1, 热峰为39.35±0.68 ℃, 平均热程为5.98±2.20天, 平均住院天数为7.16±2.29天, RSV肺炎全年均可发病, 主要分布在春冬两季;有呼吸急促者占26.19%, 有三凹征者占22.38%, 肺部有湿啰音者占77.14%, 有喘鸣音者占42.86%, 伴有心肌损害者占22.86%, 胸部影像提示细支气管炎者占15.24%;单因素分析显示, 轻度组和重度组患儿在早产、热峰、住院天数、呼吸急促、喘息、三凹征、湿啰音、喘鸣音、CRP、肺部阴影、细支气管炎方面, 差异具有统计学意义(P<0.05);通过多因素Logistic回归分析, 湿啰音和肺部阴影被确定为重症RSV肺炎的危险因素。结论在2~5岁儿童RSV肺炎中, 轻重症患儿的临床特征有一定差异, 湿啰音和肺部阴影是2~5岁儿童重症RSV肺炎的独立危险因素。

Objective To study the clinical characteristics of respiratory syncytial viral pneumonia in children aged 2 to 5 years,and pinpoint the risk factors of severe pneumonia,in order to establish a basis for early diagnosis.Methods We performed a retrospective investigation of clinical data from 210 children aged 2-5 years,diagnosed with respiratory syncytial virus pneumonia and hospitalized in our institution from December 2017 to June 2023 of New Century International Children′s Hospital,Beijing.According to the severity of their illness,they were divided into mild group and severe group.The aim was to compare their general data and clinical characteristics and to analyze the risk factors of severe respiratory syncytial viral pneumonia.Results Among 210 children infected with RSV pneumonia,the male to female ratio was 1.26∶1,with a peak body temperature of 39.35±0.68℃,an average course of fever was 5.98±2.20 days,and an average hospital stay of 7.16±2.29 days.RSV pneumonia occurred throughout the year,predominantly in spring and winter.Among the children affected,26.19%had tachypnea,22.38%had three concave sign,77.14%had moist rales in the lungs,42.86%had wheezing sounds,22.86%had myocardial damage,15.24%had diffuse panbronchiolitis.The result from the univariate analysis showed that there were statistically significant differences in preterm delivery,peak body temperature,length of hospital stay,tachypnea,wheezing,three concave sign,moist rale,wheezing sound,CRP,X-ray pulmonary shadow and diffuse panbronchiolitis between mild and severe groups(P<0.05).Multivariate logistic regression analysis showed that moist rales and X-ray lung shadows were risk factors for severe RSV pneumonia.Conclusions Importantly,certain clinical differences were observed between mild and severe cases of respiratory syncytial virus pneumonia in children aged 2 to 5 years.Moist rales and X-ray lung shadows are independent risk factors for severe respiratory syncytial viral pneumonia in children aged 2 to 5 years.