摘要
目的探讨重庆地区重症百日咳患儿临床特点。方法回顾分析2013年1月至2018年6月收治的72例重症百日咳患儿的临床资料。结果72例患儿中,男性39例、女性33例;中位年龄2.80月龄(0.80~4.39月龄),≤6月龄61例(84.7%);春季发病31例(43.1%)、冬季22例(30.6%)。62例(86.1%)未接种百白破疫苗。33例(45.8%)合并基础疾病,以营养不良、先天性心脏病多见。65例(87.5%)白细胞增多。呼吸系统并发症以呼吸衰竭(93.1%)、重症肺炎(84.7%)多见,肺外并发症则以心功能不全(18.1%)和百日咳脑病(18.1%)为主。社区病毒感染以呼吸道合胞病毒(72.4%)为主;首位细菌病原为肺炎克雷伯杆菌(23.9%),其中院内感染优势菌为肺炎克雷伯菌和鲍曼不动杆菌。经抗感染、呼吸、循环支持及对症治疗,仍有20例(27.8%)死亡。死亡组患儿外周血白细胞峰值和低血糖发生率均高于存活组,差异有统计学意义(P<0.05)。ROC曲线显示,外周血白细胞峰值>36.58×10^9/L对重症百日咳死亡预测的灵敏度、特异度分别为0.700及0.712,对应AUC为0.701。结论重庆地区开始百白破疫苗接种前的小婴儿,冬春季合并肺炎克雷伯菌感染、合并院内鲍曼不动杆菌感染或社区呼吸道合胞病毒感染的患儿罹患百日咳后易发展为重症,发生低血糖和外周血白细胞峰值>36.58×10^9/L者死亡风险高。
Objective To investigate the clinical features of children with severe pertussis in Chongqing.Methods Clinical characteristics of 72 cases of severe pertussis admitted to the Children's Hospital of Chongqing Medical University from January 2013 to June 2018 were retrospectively analyzed.Results Children under 6 months old had a higher incidence.Severe pertussis was distributed throughout the year and more common in winter and spring.Sixty-two cases(86.1%)were not vaccinated with DTP.Thirty-three cases(45.8%)with underlying diseases were more common with malnutrition(51.5%)and congenital heart disease(39.4%).There were 65 cases(87.5%)of leukocytosis.Respiratory complications were more common in respiratory failure(93.1%)and severe pneumonia(84.7%).Extrapulmonary complications were mainly cardiac insufficiency(18.1%)and pertussis encephalopathy(18.1%).Sixty-three cases(87.5%)had leukocytosis.Common respiratory complications were respiratory failure(93.1%)and severe pneumonia(84.7%).Extrapulmonary complications were cardiac insufficiency(18.1%)and pertussis encephalopathy(18.1%).Fifty-two(72.2%)children were infected with pathogens,and 39(75.0%)were in winter and spring.The virus of community acquired infection was mainly RSV(72.4%);the first bacterial pathogen was Klebsiella pneumoniae(23.9%),and the major nosocomial bacterial pathogen was Klebsiella pneumoniae pneumonia and Acinetobacter baumannii.Twenty-nine cases(40.3%)had viral infection and the predominant virus was RSV.Fourty-six cases(63.9%)had bacteria infection.The main bacteria infection was Klebsiella pneumoniae,Staphylococcus aureus and Acinetobacter baumannii.With anti-infection,respiration,circulatory support and symptomatic treatment,20 cases(27.7%)died.Comparative analysis showed that the WBC peak and incidence of hypoglycemia were significantly higher in the death group than that in the survival group(56.13±36.97 vs 31.56±22.16,P<0.05;5.8%vs 30%,P<0.05,respectively).The ROC curves of peak WBC for predicting death of severe pertussis was drawn.It was found that peak WBC>36.58×10^9/L was of high value in predicting death of severe pertussis.The predicted sensitivity and specificity were 0.700 and 0.712,respectively,and the corresponding AUC=0.701.Conclusions Severe pertussis in Chongqing mostly attacked infants without DTP vaccination.They were always combined with Klebsiella pneumoniae infection,nosocomial Acinetobacter baumannii infection or community RSV infection.Moreover,the cases which have hypoglycemia and those WBC peak>36.58×10^9/L are prone to death.
作者
张光莉
田小银
谷瑞雪
索风涛
李媛媛
骆学勤
罗健
罗征秀
Zhang Guangli;Tian Xiaoyin;Gu Ruixue;Suo Fengtao;Li Yuanyuan;Luo Xueqin;Luo Jian;Luo Zhengxiu(Respiratory Center,Children’s Hospital of Chongqing Medical University;Key Laboratory of Pediatrics in Chongqing,China International Science and Technology Cooperation Base of Child development and Critical Disorders,National Clinical Research Center for Child Health and Disorders(Chongqing),Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing,400014,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2020年第2期134-139,共6页
Journal of Clinical Pediatrics
基金
国家临床重点专科建设项目(No.2011-873)
关键词
百日咳
呼吸道病原体
临床特点
儿童
pertussis
other respiratory pathogens
clinical characteristics
child
