摘要
目的 描述学龄前儿童呼吸道合胞病毒(RSV)感染的流行病学特征,并探讨引起重症肺炎的危险因素.方法 调查279例RSV感染学龄前患儿的流行病学资料,对重症肺炎予以筛查并分成普通型和重型.比较两组一般资料、实验室检测资料,并通过二分类Logistic回归模型分析确定重症肺炎的危险因素.结果 学龄前RSV感染患儿以男性(63.08％)、＜6月龄(65.95％)、居住环境差(53.05％)居多,主要症状为咳嗽(占91.04％)、喘息(占69.18％),肺部听诊以哮鸣音(86.74％)为主,影像学表现以斑片状阴影(76.34％)为主,发病季节集中于秋季(31.18％)、冬季(43.37％).279例患儿重症肺炎检出率为20.27％(56/279).重型发病季节为秋冬季、低出生体重儿、3个月内有呼吸道感染史、延迟治疗、NEUT＜10×109/L、CRP≥10 mg/L、PCT ≥ 1.5ng/mL、白蛋白＜30 g/L、CD4+/CD8+＜1.2的患儿比例高于普通型(P＜0.05).Logistic回归分析显示,发病季节为秋冬季(OR=2.316,95％CI:1.235～4.345)、低出生体重儿(OR=2.679,95％CI:1.442～4.977)、3 个月内有呼吸道感染史(OR=2.815,95％CI:1.539～5.148)、延迟治疗(OR=2.869,95％CI:1.581～5.206)、白蛋白＜30 g/L(OR=2.756,95％CI:1.495～5.080)和 CD4+/CD8+＜1.2(OR=3.016,95％CI:1.695～5.366)为学龄前儿童发生重症RSV肺炎的危险因素(P＜0.05).结论 秋冬季、低出生体重儿、3个月内有呼吸道感染史、延迟治疗、低白蛋白和低CD4+/CD8+和学龄前儿童发生重症RSV肺炎有关,故需对具有上述危险因素的学龄前RSV感染患儿加强病情关注,针对可控性因素予以积极干预,以降低重症肺炎发生风险.
Abstract
Objective To describe the epidemiological characteristics of respiratory syncytial virus(RSV)infection in preschool children and explore the risk factors for severe pneumonia.Methods Epidemiological data of 279 preschool children with RSV infection were investigated.The children were screened for severe pneumonia and separated into ordinary and severe types.General data and laboratory test data from both groups were compared,and binary logistic regression model analysis was applied to determine the risk factors for severe pneumonia.Results Preschool children with RSV infection were mostly male(63.08％),＜6 months old(65.95％)and had poor living environment(53.05％),with main symptoms of cough(91.04％)and wheezing(69.18％),the lung auscultation was mainly characterized by wheezing(86.74％),and imaging findings were mainly patchy shadows(76.34％),the onset season was concentrated in autumn(31.18％)and winter(43.37％).The detection rate of severe pneumonia in 279 pediatric patients was 20.27％(56/279).The proportions of onset season being autumn or winter,low birth weight infants,history of respiratory infections within 3 months,delayed treatment,neutrophils count＜10× 109/L,C-reactive protein≥ 10 mg/L,procalcitonin ≥ 1.5 ng/mL,albumin＜30 g/L,CD4+/CD8+＜1.2 in the severe types were higher than those in the normal types(P＜0.05).Logistic regression analysis showed that the onset season was autumn or winter(OR=2.316,95％CI:1.235-4.345),low birth weight infants(OR=2.679,95％CI:1.442-4.977),history of respiratory infections within 3 months(OR=2.815,95％CI:1.539-5.148),delayed treatment(OR=2.869,95％CI:1.581-5.206),low albumin＜30 g/L(OR=2.756,95％CI:1.495-5.080),and low CD4+/CD8+＜1.2(OR=3.016,95％CI:1.695-5.366)were risk factors for severe RSV pneumonia in preschool children(P＜0.05).Conclusions Autumn and winter,low birth weight infants,history of respiratory infections within 3 months,delayed treatment,low albumin,and low CD4+/CD8+are related to the occurrence of severe RSV pneumonia in preschool children.Therefore,it is necessary to strengthen the attention to the condition of preschool RSV infected children with the above risk factors,and actively intervene in controllable factors to reduce the risk of severe pneumonia.
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