儿童病毒性下呼吸道感染的临床特征和炎症反应分析

Analysis of Clinical Characteristics and Inflammatory Response in Viral Lower Respiratory Tract Infections of Children

目的分析住院儿童病毒性下呼吸道感染(LRTIs)的临床特征和细胞因子表达,以阐述儿童LRTIs的内环境变化和炎症反应。方法收集2023年7月至2024年4月期间于厦门市儿童医院呼吸科住院治疗的166例单一病毒性LRTIs儿童的临床资料,根据年龄分为≤3岁组和>3岁组,两组患儿血液学、血液细胞因子和呼吸道病原学检测结果进行回顾性分析。结果两组在喘息的差异有统计学意义(P<0.05),而发热、咳嗽、气促、吸氧、入住PICU的差异无统计学意义(均P>0.05)。两组在L%、N%、CRP、ALB、AST、ALT、CK、CKMB、LDH的差异有统计学意义(均P<0.05);而在WBC、PCT、FDP、D-D的差异无统计学意义(均P>0.05)。在108例纳入的细胞因子计数中,升高的前三位分别是IL-10、INF-α、IL-6;在≤3岁组前三位分别是IL-10、IFN-α、IL-6,在>3岁组前三位分别是IL-10、IL-6、IFN-α。病毒检出率的前三位分别为呼吸道合胞病毒(RSV)、鼻病毒、偏肺病毒,RSV在≤3岁组占比最高,鼻病毒在>3岁组占比最高。结论不同年龄组儿童的LRTIs存在病毒种类的差异,造成内环境和炎症反应的不同变化。IL-10、INF-α、IL-6这三种细胞因子的高表达在LRTIs中多见。

Objective We conducted an investigation into the clinical manifestations and cytokine profiles associated with viral lower respiratory tract infections(LRTIs)in pediatric inpatients,which was to elucidate the alterations in the internal milieu and inflammatory response.Methods We conducted a retrospective analysis of clinical data of 166 cases from pediatric patients hospitalized with single viral lower respiratory tract infections(LRTIs)in the Respiratory Department of Xiamen Children's Hospital between July 2023 and April 2024.The cohort was stratified into two groups including≤3 years old group and>3 years old group based on age.Results There were statistically significant differences in wheezing between the two groups(P<0.05),but there were no statistically significant differences in fever,cough,shortness of breath,oxygen inhalation and PICU(all P>0.05).There were significant differences in L%,N%,CRP,ALB,AST,ALT,CK,CKMB and LDH between the two groups(all P<0.05).There was no significant difference in WBC,PCT,FDP and D-D(all P>0.05).Among the 108 cases included,the first three increased cytokine counts were IL-10,INF-αand IL-6.In the group≤3 years old,the first three cases were IL-10,IFN-α,and IL-6,and in the group>3 years old,the first three cases were IL-10,IL-6,and IFN-α.The top three virus detection rates were respiratory syncytial virus(RSV),rhinovirus and metapneumovirus.RSV accounted for the highest proportion in≤3 years old group,and rhinovirus accounted for the highest proportion in>3 years old group.Conclusions LRTIs in children of different age groups have difference in viral species,resulting in different changes in the internal milieu and inflammatory response.High expression of three cytokines,IL-10,INF-αand IL-6,is common in viral LRTIs.