西安地区百日咳儿童临床特征及重症危险因素  

Clinical characteristics of children with pertussis and risk factors of severe cases in Xi'an

作　　者：王军[1] 孙芳[2] 刘瑞清[1] 袁娟[1] 张玉凤[1] 徐鹏飞[1] 张瑜[1] 王小燕[1] 邓慧玲[1] Wang Jun;Sun Fang;Liu Ruiqing;Yuan Juan;Zhang Yufeng;Xu Pengfei;Zhang Yu;Wang Xiaoyan;Deng Huiling(The 2nd Department of Infectious Diseases;The 1st Department of Respiratory,Xi’an Children’s Hospital,Xi’an 710004,China)

机构地区：[1]西安市儿童医院感染二科,西安市710004 [2]西安市儿童医院呼吸一科,西安市710004

出　　处：《中华实验和临床感染病杂志（电子版）》2018年第3期244-250,共7页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的分析西安地区百日咳患儿的临床特征,为百日咳的诊治提供依据。方法回顾性分析西安地区2015年至2016年百日咳患儿的病例资料,按年龄、疫苗接种情况、病情严重程度分组,比较各组患儿的流行病学和临床特征。结果入组857例百日咳男女性别比1.21︰1,中位年龄为5.8(3.1,12.1)个月,全年散发,6~9月份为高峰期,492例(57.4%)患儿有家庭内咳嗽接触史。与>6月龄组患儿相比较,≤6月龄患儿出现痉挛性咳嗽、鸡鸣样回声、憋气呼吸暂停、重症百日咳、重症肺炎和呼吸衰竭发生率较高,住院天数更长,差异均有统计学意义(χ~2=26.517、29.939、25.632、30.740、15.046、4.476,t=4.940,P均<0.05)。与免疫组患儿相比,未免疫组患儿出现痉咳、发绀、憋气呼吸暂停、重症肺炎、重症百日咳发生率较高,且住院天数更长,差异均有统计学意义(χ~2=4.160、17.747、10.058、10.257、39.463,t=4.559,P均<0.05),两组患儿出现鸡鸣样回声以及并发百日咳脑病发生率差异无统计学意义(χ~2=0.389、1.989,P均>0.05)。与普通型百日咳病例相比,重症患儿年龄小、未接种DTP比例更高、发热和肺炎发生率高、血常规白细胞升高幅度大、住院天数长,差异均有统计学意义(χ~2=-5.713、47.214、53.394、7.993,t=7.938、-8.060,P均<0.01)。所有患儿入院治疗1周内痉挛性咳嗽消失者515例(60.1%),明显缓解者198例(23.1%),无死亡病例,住院天数中位数为8(6,10)d。结论西安地区儿童百日咳全年散发,以6~9月份为高峰期,≤6月龄未完成基础免疫的患儿临床症状较重,但预后大多良好;血常规白细胞显著增高和未接种百白破疫苗者为重症病例的独立危险因素。Objectives To investigate the clinical characteristics in patients with pertussis in Xi＇an, and to provide a scientific reference for treatment of pertussis. Methods The medical records of children with pertussis were in Xi＇an from 2015 to 2016 reviewed, which were divided few groups according to age, vaccination and severity. The epidemiological and clinical characteristics were performed in every groups, and were analyzed and compared, retrospectively. Results Among the 857 patients with pertussis, the gender ratio（male︰female） was 1.21︰1, with the median age of 5.8（3.1, 12.1） months. The cases with pertussis occur throughout the year, particularly peaking from June to September, 492 cases（57.4%） were exposed to those who coughed in their family. Compared with those older than 6 months, various symptoms such as spasmodic cough, crow-like echo, apnea and severe pertussis, severe pneumonia and respiratory failure were more common in those younger than 6 months, and had a prolonged hospital stay, with significant differences（χ~2 = 26.517, 29.939, 25.632, 30.740, 15.046, 4.476, t = 4.940; all P〈0.05）. Compared with the vaccination group, various symptoms such as spasmodic cough, cyanosis, apnea, severe pneumonia and severe pertussis were more common in cases of the non-vaccination group with a prolonged median hospital stay, with significant differences（χ~2 = 4.160, 17.747, 10.058, 10.257, 39.463, t = 4.559; all P〈0.05）. The incidences of chicken-like echogenicity and pertussis complicated with cerebropathy between cases in the two groups were without significant difference（χ~2 = 0.389, 1.989; both P〈0.05）. Compared with cases with ordinary pertussis, severe children were younger, with higher proportion of uninoculated DTP, higher incidence of fever and pneumonia, larger increase of white blood cells in routine blood detection, and longer length of hospitalization, with significant differences（χ~2 =-5.713, 47.214, 53.394, 7.993; t = 7.938,-8.060; all P〈0.01）. Among al

关 键 词：百日咳 临床特征 危险因素 

分 类 号：R725.1[医药卫生—儿科]