儿童重症百日咳临床特点及其危险因素分析

Clinical characteristics and risk factor of severe pertussis in children

目的:分析儿童重症百日咳临床特点及其危险因素,为临床诊治提供参考依据.方法:收集2018年12月—2023年3月广州医科大学附属妇女儿童医疗中心确诊的126例百日咳患儿的临床资料,分析混合感染患儿的病原体特征,并根据病情严重程度分为普通组及重症组,比较两组患儿临床资料,采用多因素Logistic回归分析进行危险因素分析.结果:两组患儿性别、年龄、发病季节、疫苗接种史、接触史、发热、气促、发绀、"鸡鸣"样回声、影像学异常、白细胞计数、血小板计数、淋巴细胞比例升高、C反应蛋白比较,差异均无统计学意义(P>0.05).两组肺部湿啰音及混合感染比较,差异均有统计学意义(P<0.05).Logistic回归分析结果显示,混合感染是重症百日咳的独立危险因素(P<0.05).百日咳患儿常存在多种病原体混合感染的现象,最常见的混合感染病原体为鼻病毒、腺病毒、金黄色葡萄球菌、肺炎支原体和肺炎链球菌等.结论:重症百日咳患儿常同时合并病毒、细菌、支原体、衣原体等多种病原体混合感染,因此诊疗过程中应尽早明确混合感染病原体种类,给予积极的抗感染及对症支持治疗,改善患儿预后.

Objective To analyze the clinical characteristics and risk factor of severe pertussis in children,so as to provide reference for clinical diagnosis and treatment.Methods The clinical data of 126 children with severe pertussis diagnosed in Women and Children's Medical Center Affiliated to Guangzhou Medical University from December 2018 to March 2023 were collected.The pathogen characteristics of the children with mixed infection were analyzed,and the children were divided into common group and severe group according to the severity of the disease.The clinical data of the two groups were compared.Multivariate Logistic regression analysis was used to analyze the risk factors.Results There were no significant differences in gender,age,disease season,vaccination history,contact history,fever,shortness of breath,cyanosis,"crowing"echo,imaging abnormalities,white blood cell count,platelet count,increased lymphocyte proportion and CRP between the two groups(P>0.05).There were significant differences in pulmonary moist rales and mixed infection between the two groups(P<0.05).Logistic regression analysis showed that mixed infection was an independent risk factor for severe pertussis(P<0.05).Children with pertussis often had a variety of pathogens mixed infection phenomenon,the most common pathogens of mixed infection are rhinovirus,adenovirus,Staphylococcus aureus,mycoplasma pneumoniae and streptococcus pneumoniae.Conclusions Children with severe pertussis are often co-infected with viruses,bacteria,mycoplasma,chlamydia and other pathogens.Therefore,in the course of diagnosis and treatment,the types of co-infected pathogens should be identified as soon as possible,and active anti-infection and symptomatic support treatment should be given to improve the prognosis of children.