南昌地区儿童重症呼吸道合胞病毒肺炎临床特征及发生危重症的危险因素分析

Clinical characteristics and risk factors of severe respiratory syncytial virus pneumonia in children in Nanchang area

目的:总结分析南昌地区儿童重症呼吸道合胞病毒(Respiratory syncytial virus,RSV)肺炎的临床特征,探讨其发生危重症的危险因素。方法:回顾性分析2019年1月1日至2021年12月31日收入江西省儿童医院住院治疗的439例重症RSV肺炎患儿的临床资料,分为重型组240例和危重型组199例,对2组患儿的一般临床资料、实验室指标、临床表现与并发症、影像学表现、治疗与转归等信息进行比较,总结儿童重症RSV肺炎的临床特征。采用多因素Logistic回归分析探讨发生危重症的危险因素。结果:2组患儿男女比例2.54∶1,中位年龄2.6(1.6,6.6)月,其中≤6月患儿322例(73.4%);全年均有发生,冬春季节为流行季节。危重型组血红蛋白(Hb)、pH、动脉血氧分压(PaO_(2))较重型组低,而血小板计数(PLT)与降钙素原值(PCT)较重型组高,差异均有统计学意义(P<0.05)。2组患儿在混合感染方面比较差异有统计学意义(P<0.05),合并病毒感染检出率明显高于细菌,以巨细胞病毒感染占优势,细菌感染以军团菌最常见。2组患儿主要临床表现(发热、咳嗽、气喘气促)比较,差异无统计学意义(P>0.05),而次要临床表现(发绀、吐沫、呼吸困难、抽搐等)比较,差异有统计学意义(P<0.05),危重型并发症以呼吸衰竭[160例(80.5%)]居多。2组患儿影像学表现均以肺部斑片状阴影为主,危重型组较重型组更易出现肺不张,差异有统计学意义(P<0.05)。危重型组氧疗率高于重型组(100%vs 95.4%),其中危重型组有创呼吸机辅助通气比例和时间均明显高于重型组,差异有统计学意义(P<0.05);危重型组使用丙种球蛋白比例高于重型组(85.9%vs36.7%),差异有统计学意义(P<0.05);危重型组三联及以上抗生素使用比例高于重型组(47.2%vs15.4%),差异有统计学意义(P<0.05),但使用时间2组比较差异无统计学意义(P>0.05);重型组住院和住ICU天数均短于危重型组,差异有统计学意义(P<0.05)。Logistic回归分析显示合并基础性疾病、混合感染是发生危重症RSV肺炎的独立危险因素。结论:⑴南昌地区儿童重症RSV肺炎好发年龄≤6月,男性居多,全年均有发生,冬春季节为主。⑵发热、咳嗽、气喘气促为主要临床表现,并发症以呼吸衰竭居多。⑶低Hb、pH值下降、PaO_(2)下降、高PLT、高PCT更能反映疾病严重程度;影像学以肺部斑片状阴影为主,危重型患儿更易出现肺不张。⑷合并基础性疾病、混合感染为危重症RSV肺炎的独立危险因素。⑸多数重症RSV肺炎患儿均能好转出院,危重型患儿疾病负担更重。

Objective:To summarize and analyze the clinical features of severe respiratory syncytial virus(RSV)pneumonia in children in Nanchang area,and to explore the risk factors of severe disease.Methods:Clinical data of 439 children with severe RSV pneumonia hospitalized in Jiangxi Children's Hospital from January 1,2019 to December 31,2021 were retrospectively studied.They were divided into severe group(240 cases)and critical group(199 cases).The general clinical data,laboratory indicators,clinical manifestations and complications,imaging manifestations,treatment and outcomes of the two groups of children were compared,and the clinical characteristics of severe RSV pneumonia in children were summarized.Multivariate Logistic regression analysis was used to studys the risk factors of severe illness.Results:The male to female ratio of the two groups was 2.54∶1,and the median age was 2.6(1.6,6.6)months,of which 322 patients(73.4%)were less than 6 months old.It occured throughout the year and was popular in winter and spring.Hemoglobin(Hb),pH and partial pressure of arterial oxygen(PaO_(2))in the critically ill group were lower than those in the severely ill group,while platelet count(PLT)and initial value of calcitonin(PCT)were higher than those in the severely ill group,and the difference between the two groups was statistically significant(P<0.05).There was significant difference in co-infection between the two groups(P<0.05).The detection rate of co-virus infection was significantly higher than that of bacteria,and cytomegalovirus infection was dominant.Legionella is the most common bacterial infection.There was no significant difference in the main clinical manifestations(fever,cough,wheezing and shortness of breath)between the two groups(P>0.05),while there was significant difference in the secondary clinical manifestations(cyanosis,spitting,dyspnea,convulsions,etc.)between the two groups(P<0.05),and respiratory failure was the most serious complication in 160 cases(80.5%).Pulmonary patchy shadow was predominant in both groups,and atelectasis was more likely to occur in the critical group than in the severe group,with statistically significant(P<0.05).The oxygen therapy rate of the critical group was higher than that of the severe group(100%vs95.4%),and the proportion and duration of invasive ventilator-assisted ventilation in the critical group were significantly higher than those in the severe group,with statistical significance(P<0.05).The proportion of intravenous gamma globulin use in severe group was higher than that in severe group(85.9%vs 36.7%),and the difference was statistically significant(P<0.05).The proportion of three or more antibiotics used in severe group was higher than that in severe group(47.2%vs15.4%),and the difference was statistically significant(P<0.05),but there was no statistically significant difference in the use time between the two groups(P>0.05).The days of hospitalization and ICU stay in severe group were shorter than those in critical group,and the difference was statistically significant(P<0.05).Logistic regression analysis showed that combined underlying disease and mixed infection were independent risk factors for severe RSV pneumonia.Conclusion:⑴The predilection age of severe RSV pneumonia in children in Nanchang area was less than 6 months,mainly in male children.It occured all year round and was prevalent in winter and spring.⑵Fever,cough,asthma and shortness of breath were the main clinical manifestations,and most of the complications were respiratory failure.⑶Lower HGB,lower pH,lower PaO_(2),higher PLT,higher PCT could better reflect the severity of the disease;Pulmonary patchy shadows were predomi‐nant in imaging,and atelectasis was more common in the critical type group.⑷Combined underlying diseases and mixed infection were independent risk factors for severe RSV pneumonia.⑸Most children with severe RSV pneumonia could get better and be discharged from hospital.The disease burden of the critically ill group was heavier.