百日咳患儿的临床病理特征及重症百日咳早期预警危险因素

Clinical Pathological Characteristics and Early Warning Risk Factors for Severe Pertussis in Children

目的探讨124例百日咳患儿的临床病理特征及重症百日咳早期预警危险因素。方法将2020年4月至2023年5月期间在河南省永城市中心医院接受治疗的124例百日咳患儿的临床资料行回顾性分析,以病情严重程度为依据将其分为普通组(98例)和重症组(26例)。采集患儿临床资料,包括临床表现(痉挛样咳嗽、阵发性咳嗽、咳嗽剧烈时伴面色潮红等)、体征(三凹征、哮鸣音、湿啰音)、并发症情况(急性支气管炎、支气管肺炎、重症肺炎等)、合并其他病原体感染情况(肺炎链球菌、肺炎支原体、金黄色葡萄球菌等)、胸部影像学表现(支气管炎、支气管肺炎、肺不张/肺实变等)等,对上述资料进行单因素分析,根据分析结果对差异有统计学意义的变量行多因素二元Logistic回归分析,以筛选出重症百日咳的独立危险因素。结果单因素分析结果显示,百日咳重症组患儿存在发热、三凹征、合并其他病原体感染、肺实变/肺不张、白细胞计数升高的占比显著多于普通组患儿,接种百白破联合疫苗(DPT)的百日咳重症患儿占比显著少于普通组患儿,差异有统计学意义(P<0.05)。本研究多因素二元Logistic回归分析的结果中可见,未接种DTP、肺实变/肺不张及白细胞计数升高均为重症百日咳患儿的独立危险因素(OR=20.328、23.173、1.294,P<0.05)。结论未接种DTP、肺实变/肺不张及白细胞计数升高均为重症百日咳患儿的独立危险因素,临床可根据以上因素制定针对性措施。

Objective To explore the clinical pathological characteristics and early warning risk factors for severe pertussis in 124 children.Methods A retrospective analysis of clinical data from 124 children treated for pertussis at Yongcheng Central Hospital between April 2020 and May 2023.The children were divided into a general group(98 cases)and a severe group(26 cases)based on the severity of their condition.Clinical data collected included symptoms(spasmodic cough,paroxysmal cough,cough with facial flushing,etc.),signs(three concave sign,wheezing,moist rales),complications(acute bronchitis,bronchopneumonia,severe pneumonia),co-infections(Streptococcus pneumoniae,Mycoplasma pneumoniae,Staphylococcus aureus,etc.),and chest imaging findings(bronchitis,bronchopneumonia,atelectasis/consolidation).A univariate analysis was conducted,and statistically significant variables were further analyzed using multivariate binary logistic regression to identify independent risk factors for severe pertussis.Results Univariate analysis showed that fever,three concave sign,co-infections,lung consolidation/atelectasis,and elevated white blood cell count were significantly more common in the severe group than in the general group.Fewer children in the severe group had received the diphtheria,pertussis,and tetanus(DPT)vaccine.Multivariate binary logistic regression revealed that lack of DTP vaccination,lung consolidation/atelectasis,and elevated white blood cell count were independent risk factors for severe pertussis(OR=20.328,23.173,1.294,P<0.05).Conclusion Lack of DTP vaccination,lung consolidation/atelectasis,and elevated white blood cell count are independent risk factors for severe pertussis in children.Clinicians can use these factors to develop targeted interventions.