SARS感染孕产妇、新生儿及儿童、青少年的系统评价  

A systematic review of SARS-infected pregnant females,newborns,children and adolescents

作　　者：李文星 唐军 曾燕[1,2] 岳艳 何洋[1,2] 张萌 胡鹏 熊涛[1,2] 母得志 李幼平[3] LI Wenxing;TANG Jun;ZENG Yan;YUE Yan;HE Yang;ZHANG Meng;HU Peng;XIONG Tao;MU Dezhi;LI Youping(Department of Pediatrics,West China Second Hospital,Sichuan University,Chengdu 610041,P.R.China;Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,Chengdu 610041,P.R.China;Chinese Evidence-based Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西第二医院儿科,成都610041 [2]出生缺陷与相关妇儿疾病教育部重点实验室,成都610041 [3]四川大学华西医院中国循证医学中心,成都610041

出　　处：《中国循证医学杂志》2020年第4期426-436,共11页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价孕产妇、新生儿、儿童和青少年感染SARS的临床资料特征及感染对妊娠结局、胎儿和新生儿的预后影响。方法计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、CNKI、WanFang Data和VIP数据库,查找SARS感染孕产妇、新生儿、儿童和青少年相关的临床研究。描述性分析孕产妇、儿童、婴儿感染SARS的基线特征、临床表现、治疗措施和预后。结果共纳入13个研究,包括81例儿童和青少年、19例孕产妇和14例新生儿。在81例儿童和青少年人群的报告中,患儿男女比例1∶1.2,年龄从56日龄的早产婴儿到17.5岁的青少年,其中小于12岁儿童占58.3%(28/48),有密切接触史的患儿占34.0%(16/47)。发热(93.8%,76/81)和咳嗽(49.4%,40/81)是最主要症状,出现呼吸急促/呼吸困难的比例为17.5%(11/63)。SARS-CoV的RT-PCR检测阳性病例为29.2%(14/48),SARS-CoV血清抗体阳性病例占92.9%(13/14)。实验室检查以外周血淋巴细胞减低最为常见(65.1%,44/67);影像学检查约70.8%(51/72)患儿存在单侧病变,29.2%(21/72)为双侧病变。仅1例婴儿病例为重症,无儿童死亡病例。孕产妇患者年龄为23岁~44岁。孕早、中期感染占52.6%(10/19),孕晚期47.4%(9/19)。SARS孕妇临床表现以发热(100.0%,19/19)和咳嗽(78.9%,15/19)为主,出现呼吸急促或呼吸困难占比为36.8%(7/19)。实验室检查显示SARS-CoV核酸阳性率为50.0%(8/16),SARS-CoV血清抗体阳性达93.3%(14/15);血小板减少、淋巴细胞减少和肝酶异常的比例分别为38.9%(7/18)、61.1%(11/18)和50.0%(3/6)。100%(19/19)SARS孕妇肺部影像学检查均有肺炎改变。重症患者比例为36.8%(7/19),机械通气患者占26.3%(5/19),15.8%(3/19)患者死亡。自然流产比例为40.0%(4/10),剖宫产率为75.0%(9/12)。SARS孕妇胎儿发生宫内窘迫6例(46.2%),早产7例(53.8%),宫内发育迟缓3例(23.1%)。SARS孕妇所生14例新生儿均未确诊为SARS感染。结论儿童、青少年SARS感染的临床症�Objectives To systematically review the clinical characteristics of pregnant females,newborns,children and adolescents with SARS infection.Methods The clinical characteristics of patients with SARS infection were searched using PubMed,EMbase,Web of Science,The Cochrane Library,CNKI,WanFang Data and VIP databases.Descriptive analysis was performed to analyze the clinical characteristics of the patients,clinical manifestations,treatment and prognosis.Results A total of 13 studies including 19 pregnant females,14 newborns,and 81 children and adolescents were identified.The ratio of male to female was 1 to 1.2 in children and adolescents patients aged 56 days to17.5 years.Children under 12 years old accounted for 58.3%(28/48).Of the child patients,34.0%(16/47)had close contact with patients with SARS.Fever(93.8%,76/81)and cough(49.4%,40/81)were the most common symptoms in children and adolescents with SARS infection,and 17.5%(11/63)occurred with shortness of breath or dyspnea.The positive ratio of nucleic acid detection for SARS-CoV was 9.2%(14/48),and the positive ratio of serum antibody was 92.9%(13/14).Peripheral blood lymphocyte reduction was approximately 65.7%(44/67).Approximately 70.8%(51/72)unilateral and29.2%(21/72)bilateral lesions were found by thoracic X-ray or CT scan.No child fatalities were reported.As of maternal patients,aged 23 to 44 years,10 cases(52.6%)were infected during early and middle pregnancy,and 9 cases(47.4%)during late pregnancy.Fever(100.0%,19/19)and cough(78.9%,15/19)were the main clinical symptoms,and shortness of breath/dyspnea occurred in 36.8%(7/19)of infected pregnant females.The positive ratio of nucleic acid detection for SARS-CoV was 50.0%(8/16),whereas the positive ratio of serum antibody was 93.3%(14/15).The ratios of thrombocytopenia,lymphopenia,and liver enzymes abnormalities were 38.9%(7/18),61.1%(11/18)and 50.0%(3/6).All patients were identified for lesions by thoracic X-ray or CT scan examination.Seven cases were severe(36.8%).Five patients were treated with mechanical v

关 键 词：严重急性呼吸道综合征 SARS-COV 儿童 婴儿 新生儿 青少年 孕产妇 系统评价 

分 类 号：R511.9[医药卫生—内科学]