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中华诊断学电子杂志 ›› 2024, Vol. 12 ›› Issue (01) : 44 -49. doi: 10.3877/cma.j.issn.2095-655X.2024.01.007

临床研究

鲁西南地区儿童呼吸道合胞病毒肺炎临床特征分析
吴敬芳1, 谭清实2, 郗夏颖1, 樊节敏1, 韩蕾1, 辛美云1,()   
  1. 1. 272029 济宁医学院附属医院儿科
    2. 272029 济宁医学院附属医院急诊科
  • 收稿日期:2023-02-10 出版日期:2024-02-26
  • 通信作者: 辛美云
  • 基金资助:
    济宁市重点研发计划项目(2022YXNS181)

Analysis of clinical characteristics of respiratory syncytial virus pneumonia in children in Southwest Shandong

Jingfang Wu1, Qingshi Tan2, Xiaying Xi1, Jiemin Fan1, Lei Han1, Meiyun Xin1,()   

  1. 1. Department of Pediatrics, Affiliated Hospital of Jining Medical University, Jining 272029, China
    2. Department of Emergency, Affiliated Hospital of Jining Medical University, Jining 272029, China
  • Received:2023-02-10 Published:2024-02-26
  • Corresponding author: Meiyun Xin
引用本文:

吴敬芳, 谭清实, 郗夏颖, 樊节敏, 韩蕾, 辛美云. 鲁西南地区儿童呼吸道合胞病毒肺炎临床特征分析[J]. 中华诊断学电子杂志, 2024, 12(01): 44-49.

Jingfang Wu, Qingshi Tan, Xiaying Xi, Jiemin Fan, Lei Han, Meiyun Xin. Analysis of clinical characteristics of respiratory syncytial virus pneumonia in children in Southwest Shandong[J]. Chinese Journal of Diagnostics(Electronic Edition), 2024, 12(01): 44-49.

目的

分析鲁西南地区儿童呼吸道合胞病毒(RSV)肺炎的临床特征,探讨发生重症RSV肺炎的相关因素。

方法

回顾性分析2021年10月至2022年9月济宁医学院附属医院儿科收治的252例RSV肺炎患者的临床资料。根据病情严重程度分为轻症肺炎组(n=168)及重症肺炎组(n=84),对两组临床资料进行比较,运用多因素Logistic回归分析发生重症RSV肺炎的危险因素。

结果

男童156例(61.90%),女童96例(38.10%),男女比1.63∶1。RSV感染率较高的3个年龄组分别为年龄≤3个月(60.32%,152/252)、3~6个月(21.83%,55/252)、6月~1岁(7.94%,20/252)。接触呼吸道感染人群(看护人/共同居住者患呼吸道感染)后发病患者146例(57.94%);有基础疾病患者38例(15.08%)。重症RSV肺炎组与轻症RSV肺炎组在贫血(19.05%,10.12%)、发热(55.95%,29.76%)、喘息(57.14%,39.88%)、有基础疾病(28.57%,8.33%)方面比较,均差异有统计学意义(χ2=3.92,16.23,6.73,17.91;均P<0.05)。重症RSV肺炎组患者住院时间更长[(8.86±3.71)d,(7.67±1.95)d],治疗上需要氧疗(65.48%,14.29%)、静注人免疫球蛋白(38.10%,5.95%)、糖皮质激素(38.10%,25.00%)比例明显增高,差异有统计学意义(t=3.32,χ2=68.19,41.66,4.63;均P<0.05)。重症RSV肺炎组患者白细胞数[(8.66±3.58)×109/L]、C反应蛋白[1.16(0.25,12.19)mg/L]、乳酸脱氢酶[(353.09±113.89)U/L]、α-羟丁酸脱氢酶[(272.80±89.65)U/L]较轻症RSV肺炎组[(7.86±2.40)×109/L,0.57(0.26,2.35)mg/L,(288.29±73.13)U/L,(223.02±49.39)U/L]增高,差异有统计学意义(t=2.09,Z=2.22,t=5.40,5.60;均P<0.05)。将单因素分析显示有统计学意义的变量进行多因素Logistic分析,结果显示发热、喘息、存在基础疾病、乳酸脱氢酶水平升高是发生重症RSV肺炎的独立危险因素(OR=18.019,2.564,4.275,2.348;均P<0.05)。

结论

RSV肺炎可发生在所有年龄组儿童,尤其是1岁以下婴儿多见。存在基础疾病、发热、喘息、乳酸脱氢酶升高是发展成重症RSV肺炎的独立危险因素。

Objective

To analyze the clinical characteristics of respiratory syncytial virus (RSV) pneumonia in children in Southwest Shandong, and explore the factors associated with severe RSV pneumonia occurrence.

Methods

Retrospective analysis was conducted on the clinical data of 252 cases of RSV pneumonia admitted to the Department of Pediatrics at Affiliated Hospital of Jining Medical University from October 2021 to September 2022. According to the severity of the condition, the cases were categorized into mild pneumonia group(n=168) and severe pneumonia group(n=84). A comparative analysis of the clinical data of the 2 groups was performed, and a multivariate Logistic regression analysis was used to identify the risk factors associated with the occurrence of severe RSV pneumonia.

Results

The study included 252 cases of RSV pneumonia, with 156 boys (61.90%) and 96 girls (38.10%), resulting in a male-to-female ratio of 1.63∶1. The 3 age groups with the highest RSV infection rates were aged ≤3 months (60.32%, 152/252), 3-6 months (21.83%, 55/252), and 6 months to 1 year (7.94%, 20/252). Of the total, 146 patients (57.94%) had a history of contact with respiratory infectious diseases became ill after exposure to respiratory infections (caregivers or co-residents underwent respiratory infections), 38 patients (15.08%) had underlying diseases. The differences between the severe RSV pneumonia group and the mild RSV pneumonia group were statistically significant in terms of anemia (19.05%, 10.12%), fever (55.95%, 29.76%), wheezing (57.14%, 39.88%), and having underlying disease (28.57%, 8.33%) (χ2=3.92, 16.23, 6.73, 17.91, all P<0.05). Patients in the severe RSV pneumonia group had a longer hospital stay [(8.86±3.71)d, (7.67±1.95)d], and a higher proportion of requiring oxygen therapy (65.48%, 14.29%), intravenous immunoglobulin therapy (38.10%, 5.95%), and glucocorticoid therapy (38.10%, 25.00%) compared to the mild RSV group. These differences were statistically significant (t=3.32, χ2=68.19, 41.66, 4.63, all P<0.05). Compared to the mild RSV group, the severe RSV pneumonia group had higher white blood cell count [(8.66±3.58)×109/L], C-reactive protein level [1.16(0.25, 12.19)mg/L], lactate dehydrogenase level [(353.09±113.89)U/L], and α-hydroxybutyrate dehydrogenase level [(272.80±89.65)U/L] compared to mild RSV group [(7.86±2.40)×109/L, 0.57(0.26, 2.35)mg/L, (288.29±73.13)U/L, (223.02±49.39)U/L], with statistically significant differences (t=2.09, Z=2.22, t=5.40, 5.60, all P<0.05). The variables that showed statistical significance in the univariate analysis were then subjected to multivariate Logistic analysis, which showed that fever, wheezing, presence of underlying disease and elevated lactate dehydrogenase level were independent risk factors for the development of severe RSV pneumonia (OR=18.019, 2.564, 4.275, 2.348, all P<0.05).

Conclusions

RSV pneumonia can occur in children of all age groups and is particularly prevalent in infants under 1 year old. The presence of underlying disease, fever, wheezing and elevated lactate dehydrogenase level are independent risk factors for the development of severe RSV pneumonia.

表1 252例呼吸道合胞病毒肺炎患儿一般情况
表2 不同年龄组呼吸道合胞病毒肺炎患者临床特征比较
项目 ≤3月(n=152) 3~6月(n=55) 6月~1岁(n=20) 1~2岁(n=8) >2岁(n=17)
咳嗽[例(%)] 152(100.00) 55(100.00) 20(100.00) 8(100.00) 17(100.00)
发热[例(%)] 37(24.34) 22(40.00) 16(80.00) 8(100.00) 14(82.35)
≤38℃ 22(14.47) 9(16.36) 4(20.00) 1(12.50) 0
38.1℃~39℃ 11(7.24) 11(20.00) 8(40.00) 0 4(23.53)
39.1℃~40℃ 3(1.97) 2(3.64) 3(15.00) 7(87.50) 8(47.06)
≥40.1℃ 1(0.66) 0 1(5.00) 0 2(11.76)
喘息[例(%)] 54(35.53) 39(70.91) 15(75.00) 4(50.00) 3(17.65)
气促[例(%)] 67(44.08) 31(56.36) 11(55.00) 5(62.50) 2(11.76)
心率增快[例(%)] 33(21.71) 10(18.18) 3(15.00) 3(37.50) 3(17.65)
精神状态改变[例(%)] 27(17.76) 11(20.00) 4(20.00) 1(12.50) 9(52.94)
嗜睡 11(7.24) 3(5.45) 2(10.00) 0 2(11.76)
睡眠不安 16(10.53) 8(14.55) 2(10.00) 1(12.50) 7(41.18)
食欲下降[例(%)] 63(41.45) 22(40.00) 9(45.00) 1(12.50) 5(29.41)
腹胀[例(%)] 15(9.87) 3(5.45) 3(15.00) 0 0
腹泻[例(%)] 73(48.03) 29(52.73) 12(60.00) 1(12.50) 1(5.88)
重症肺炎[例(%)] 45(29.61) 11(20.00) 7(35.00) 7(87.50) 14(82.35)
心肌损害[例(%)] 63(41.45) 26(47.27) 8(40.00) 3(37.50) 3(17.65)
电解质紊乱[例(%)] 68(44.74) 37(67.27) 11(55.00) 5(62.50) 9(52.94)
氧疗[例(%)] 55(36.18) 10(18.18) 6(30.00) 4(50.00) 4(23.53)
鼻导管吸氧 31(20.39) 5(9.09) 1(5.00) 2(25.00) 3(17.65)
高流量吸氧 3(1.97) 0 2(10.00) 0 0
无创呼吸支持 20(13.16) 2(3.64) 3(15.00) 2(25.00) 0
有创呼吸支持 1(0.66) 3(5.45) 0 0 1(5.88)
混合感染[例(%)] 49(32.24) 20(36.36) 10(50.00) 4(50.00) 10(58.82)
静注人免疫球蛋白[例(%)] 29(19.08) 8(14.55) 1(5.00) 2(25.00) 2(11.76)
纤维支气管镜检查及镜下治疗[例(%)] 3(1.97) 1(1.82) 2(10.00) 3(37.50) 13(76.47)
全身糖皮质激素[例(%)] 38(25.00) 19(34.55) 8(40.00) 4(50.00) 5(29.41)
干扰素治疗[例(%)] 120(78.95) 41(74.55) 12(60.00) 0 0
中医药治疗[例(%)] 53(34.87) 19(34.55) 6(30.00) 2(25.00) 6(35.29)
住院时间(d,±s) 8.01±2.12 7.98±4.16 7.85±2.46 9.00±2.14 8.65±2.37
表3 两组呼吸道合胞病毒肺炎患者临床特征比较
表4 两组呼吸道合胞病毒肺炎患者实验室指标比较
项目 重症组(n=84) 轻症组(n=168) 统计量 P
白细胞数(×109/L,±s) 8.66±3.58 7.86±2.40 t=2.09 0.038
C反应蛋白[mg/L,M(Q1Q3)] 1.16(0.25,12.19) 0.57(0.26,2.35) Z=2.22 0.027
降钙素原[μg/L,M(Q1Q3)] 0.17(0.11,0.30) 0.16(0.10,0.23) Z=0.69 0.491
D-二聚体[mg/L,M(Q1Q3)] 0.44(0.26,0.63) 0.29(0.16,0.37) Z=1.17 0.244
血红蛋白(g/L,±s) 112.45±21.84 116.17±14.91 t=-1.59 0.113
白蛋白(g/L,±s) 40.39±4.35 40.13±4.25 t=0.45 0.657
前白蛋白(mg/L,±s) 132.33±44.26 127.81±33.35 t=0.89 0.375
谷丙转氨酶[U/L,M(Q1Q3)] 19.40(14.30,27.40) 22.10(14.75,32.45) Z=-1.49 0.137
谷草转氨酶[U/L,M(Q1Q3)] 33.00(26.00,44.75) 36.00(29.00,46.50) Z=-1.24 0.217
肌酸激酶[U/L,M(Q1Q3)] 81.00(62.00,123.00) 117.75(83.50,81.00) Z=-0.86 0.861
肌酸激酶同工酶(μg/L,±s) 3.73±1.77 3.47±1.37 t=1.29 0.199
乳酸脱氢酶(U/L,±s) 353.09±113.89 288.29±73.13 t=5.40 0.000
α-羟丁酸脱氢酶(U/L,±s) 272.80±89.65 223.02±49.39 t=5.60 0.000
血钠(mmol/L,±s) 137.35±3.87 137.72±1.81 t=-1.04 0.300
血氯(mmol/L,±s) 102.00±4.54 103.68±2.06 t=-3.99 0.000
血钾(mmol/L,±s) 4.51±0.73 4.79±0.46 t=-3.73 0.000
血碳酸氢盐(mmol/L,±s) 20.74±4.10 20.74±2.46 t=0 1.000
血钙(mmol/L,±s) 2.41±0.17 2.49±0.18 t=-3.32 0.010
血镁(mmol/L,±s) 0.97±0.21 0.94±0.10 t=1.66 0.098
血磷(mmol/L,±s) 1.73±0.54 1.71±0.53 t=0.07 0.946
表5 预测重症呼吸道合胞病毒肺炎的Logistic回归分析
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