摘要
目的 分析深圳市儿童医院2024年1-3月儿童百日咳住院病例的临床特征,进一步探讨重症百日咳的相关危险因素.方法 收集2024年1-3月深圳市儿童医院收治的283例百日咳住院病例的临床与胸部影像资料,依据病情严重程度分非重症组(253例)和重症组30(例),重症患儿依据临床结局分存活组(25例)和死亡组(5例).比较各组间临床指标及影像学特点,分析重症百日咳的危险因素,并采用接受者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析不同指标及联合指标的预测效能.结果 283例病例中年龄≤3月龄139例(49.1％),有咳嗽患者接触史151例(53.4％),接种过百白破疫苗117例(41.3％),合并百日咳脑病4例(1.4％).重症组患儿的发病年龄≤3月龄、无疫苗接种史、肺不张、肺动脉高压、呼吸衰竭、百日咳脑病、呼吸机有创通气、换血术比例及白细胞计数、中性粒细胞计数、淋巴细胞计数、中性粒细胞比值、C反应蛋白(C-reactive protein,CRP)、乳酸脱氢酶水平均高于非重症组,差异有统计学意义(P＜0.05).死亡组患儿咳嗽后呕吐比例、中性粒细胞比值、CRP以及呼吸机有创通气比例均高于存活组,差异有统计学意义(P＜0.05).年龄≤3月龄、中性粒细胞比值、CRP、肺不张及肺动脉高压是重症百日咳的相关危险因素,ROC曲线分析结果显示,以上5个因素联合预测敏感度为0.933,特异度为0.762,曲线下面积为0.888(95％CI 0.816～0.961).结论 百日咳住院患儿年龄≤3月龄、中性粒细胞比值和CRP升高、合并肺不张和/或肺动脉高压时易发展为重症,监测血常规及CRP有助于病情严重程度的判断.
Abstract
Objective To analyze the clinical and chest imaging characteristics of hospitalized patients with pertussis in Shenzhen Children's Hospital from January to March 2024,and explore the relevant risk factors for severe pertussis.Method Clinical and chest radiology data of 283 inpatients with pertussis hospitalized in Shenzhen Children's Hospital from January to March 2024 were collected.According to the severity of pertussis,they were divided into non-severe group(253 cases)and severe group(30 cases).The severe group patients were subdivided into survival group(25 cases)and death group(5 cases)according to clinical outcomes.Compare clinical indicators and radiology characteristics between these two groups,analyze risk factors for severe pertussis,and use ROC curves to analyze the predictive efficacy of different indicators and combined indicators.Result Toltaly 283 pediatric patients,among them 139 patients(49.1％)≤3 months old,151 cases(53.4％)got a history of contact with cough patients,117 cases(41.3％)had received the pertussis vaccine,Four cases(1.4％)had pertussis encephalopathy.Compared with the non-severe group,the severe group had higher index in percentage of onset age(≤3 months old),no vaccination,atelectasis,pulmonary arterial hypertension,respiratory failure,pertussis encephalopathy,invasive ventilation with respiratory machines,the use of blood exchange surgery and white blood cell count,neutrophil count,lymphocyte count,neutrophil ratio,CRP,lactate dehydrogenase,with statistically significant difference(P＜0.05).Compared with the survival group,the death group had higher index in proportion with vomiting after coughing,neutrophil ratio,CRP and invasive ventilation with ventilators,with statistically significant difference(P＜0.05).Age≤3 months,neutrophil ratio,CRP,atelectasis,and pulmonary arterial hypertension were related risk factors for severe pertussis.The ROC curve analysis results showed that the combined predictive sensitivity of age≤3 months,neutrophil ratio and CRP,atelectasis,and pulmonary arterial hypertension was 0.933,specificity was 0.762,and the area under the curve was 0.888(95％CI 0.816-0.961)(P＜0.001).Conclusion When the age of the patient was≤3 months,the proportion of neutrophils and CRP increased,and combined with atelectasis and/or pulmonary arterial hypertension,it is inclined to develop into severe illness.Monitoring blood routine and CRP can help evaluate the severity of the condition.
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