中国北方六省(自治区)儿童2019新型冠状病毒感染31例临床分析  

Clinical analysis of 31 cases of 2019 novel coronavirus infection in children from six provinces(autonomous region)of northern China

作　　者：王端 鞠秀丽[2] 谢峰[3] 芦燕 李飞宇 黄辉红[6] 方秀玲 李元军 王建云 易彬[10] 岳菊侠 王静[12] 王凌啸 李博[14] 王义[15] 邱丙平[16] 周志远[17] 李可亮[18] 孙建华[19] 刘学工[20] 李国栋 王永军[10] 曹爱华[2] 陈艳妮[1] Wang Duan;Ju Xiuli;Xie Feng;Lu Yan;Li Feiyu;Huang Huihong;Fang Xiuling;Li Yuanjun;Wang Jianyun;Yi Bin;Yue Juxia;Wang Jing;Wang Lingxiao;Li Bo;Wang Yi;Qiu Bingping;Zhou Zhiyuan;Li Keliang;Sun Jianhua;Liu Xuegong;Li Guodong;Wang Yongjun;Cao Aihua;Chen Yanni(Department of Pediatric Internal Medicine,Xi′an Children′s Hospital,Xi′an 710003,China;Department of Pediatrics,Qilu Hospital of Shandong University,Jinan 250012,China;Pediatric Intensive Care Unit,General Hospital of Ningxia University,Yinchuan 750004,China;Department of Pediatrics,the Fourth People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750021,China;Department of Intensive Care Unit,Xi′an Number Eighth Hospital,Xi′an 710061,China;Department of Infectious Diseases,Ankang Central Hospital,Ankang 725000,China;Department of Pediatrics,Tongchuan Mining Bureau Central Hospital,Tongchuan 727000,China;Department of Respiratory Medicine,Yan′an Second People′s Hospital Affiliated to Yan′an University,Yan′an 716000,China;Department of Infectious Diseases,Lanzhou Pulmonology Hospital,Lanzhou 730046,China;Department of Pediatrics,Gansu Provincial Maternity and Child-Care Hospital,Lanzhou 730050,China;Department of Pediatrics,Xianyang Central Hospital,Xianyang 712000,China;Department of Respiratory Medicine,Children′s Hospital Affiliated to Zhengzhou University,Zhengzhou 450018,China;Pediatric Critical Care Medicine,Zhumadian Central Hospital,Zhumadian 463000,China;Department of Pediatrics,Shijiazhuang Fifth Hospital,Shijiazhuang 050024,China;Department of Neonatal Intensive Care Unit,the Affiliated Children′s Hospital of Xi′an Jiaotong University,Xi′an 710003,China;Department of Pediatrics,Tengzhou Central People′s Hospital,Tengzhou 277500,China;Department of Pediatrics,Heze Municipal Hospital,Heze 274000,China;Department of Pediatrics,People′s Hospital of Rizhao,Rizhao 276800,China;Department of Infectious Diseases,Yantai Laiyang Central Hospital,Yantai 264000,China;Department of Pediatrics,Weihai Municipal Hospital,Weihai 264

机构地区：[1]西安市儿童医院儿内科,710003 [2]山东大学齐鲁医院儿科,济南250012 [3]宁夏医科大学总医院儿科重症监护病房,银川750004 [4]宁夏回族自治区第四人民医院儿科,银川750021 [5]西安市第八医院重症医学科,710061 [6]陕西省安康市中心医院感染性疾病科,725000 [7]陕西省铜川矿务局中心医院儿科,727000 [8]延安大学附属延安市第二人民医院呼吸内科,716000 [9]兰州市肺科医院感染内科,730046 [10]甘肃省妇幼保健院儿科,兰州730050 [11]咸阳市中心医院儿科,712000 [12]郑州大学附属儿童医院呼吸科,450018 [13]河南省驻马店市中心医院儿童重症医学科,463000 [14]石家庄市第五医院儿科,050024 [15]西安交通大学附属儿童医院新生儿重症医学科,710003 [16]山东省滕州市中心人民医院儿科,277500 [17]山东省菏泽市立医院儿科,274000 [18]山东省日照市人民医院儿科,276800 [19]烟台市莱阳中心医院感染性疾病科,264000 [20]威海市立医院儿科,264200 [21]甘肃省平凉市人民医院感染性疾病科,744000

出　　处：《中华儿科杂志》2020年第4期269-274,共6页Chinese Journal of Pediatrics

摘　　要：目的 分析中国北方6省(自治区)儿童2019新型冠状病毒(2019-nCoV)感染者的流行病学史、临床表现、治疗及近期预后。方法 回顾性总结陕西、甘肃、宁夏、河北、河南、山东6省(自治区)17市21家医院于2020年1月25日至2月21日经2019-nCoV核酸检测确诊的31例患儿的病例资料,分析其流行病学史、临床症状、体征、实验室检查、胸部影像学以及治疗和近期预后情况。结果 31例患儿年龄7岁1月龄(6月龄~17岁)。9例(29%)为输入性病例,21例(68%)有确诊成人患者接触史,1例(3%)曾接触过无症状的武汉返乡人员。31例患儿中28例(90%)为家庭聚集性发病。临床分型为无症状型4例(13%),轻型13例(42%),普通型14例(45%),无重型及危重型。症状发生频率最高为发热(20例,65%),其中高热1例、中度发热9例、低热10例,热程1~9 d,15例≤3 d,5例>3 d;其余依次为咳嗽(14例,45%),乏力(3例,10%),腹泻(3例,10%),咽痛、流涕、头晕、头痛、呕吐等少见。早期外周血白细胞总数减少者、淋巴细胞数减少者、血小板增多者各2例(6%)。C反应蛋白升高(10%,3/30),红细胞沉降率升高(19%,4/21),降钙素原升高(4%,1/28),血清转氨酶升高(22%,6/27)及肌酶升高(15%,4/27)也有不同比例出现。检测肾功能及血糖者均未见异常。14例患儿胸部CT有异常改变,其中9例呈斑片状磨玻璃阴影及结节,多位于双肺中外带、近胸膜区。31例患儿给予一般治疗后25例病毒核酸检测转阴(7~23 d),其中24例(77%)痊愈出院,无死亡病例。结论 中国北方6省(自治区)31例儿童2019-nCoV感染以家庭内密切接触为主要感染途径,呈无症状型、轻型和普通型,临床表现及实验室检查结果无特异性。流行病学密切接触史、病毒核酸检测及胸部影像学是儿童2019-nCoV感染诊断的重要参考依据,给予一般治疗,近期预后整体良好。Objective To analyze the epidemiological history,clinical manifestations,treatment and the short-term prognosis of 31 cases of 2019 novel coronavirus(2019-nCoV)infection in children from six provinces(autonomous region)in northern China.Methods A retrospective analysis of the epidemiological history,clinical symptoms,signs,laboratory examinations,chest imaging,treatment and the short-term prognosis of 31 cases of 2019-nCoV was conducted.The patients were diagnosed between January 25th,2020 and February 21st,2020 in 21 hospitals in 17 cities of six provinces(autonomous region)of Shaanxi,Gansu,Ningxia,Hebei,Henan and Shandong.Results The age of the 31 children with 2019-nCoV infection was 7 years and 1 month(6 months-17 years).Nine cases(29%)were imported cases.Other 21 cases(68%)had contact with confirmed infected adults.One case(3%)had contact with asymptomatic returnees from Wuhan.Among the 31 children,28 patients(90%)were family cluster cases.The clinical types were asymptomatic type in 4 cases(13%),mild type in 13 cases(42%),and common type in 14 cases(45%).No severe or critical type existed.The most common symptom was fever(n=20,65%),including 1 case of high fever,9 cases of moderate fever,10 cases of low fever.Fever lasted from 1 day to 9 days.The fever of fifteen cases lasted for≤3 d,while in other 5 cases lasted>3 d.Other symptoms included cough(n=14,45%),fatigue(n=3,10%)and diarrhea(n=3,10%).Pharyngalgia,runny nose,dizziness,headache and vomiting were rare.In the early stage,the total leukocytes count in peripheral blood decreased in 2 cases(6%),the lymphocytes count decreased in 2 cases(6%),and the platelet count increased in 2 cases(6%).Elevation of C-reactive protein(10%,3/30),erythrocyte sedimentation rate(19%,4/21),procalcitonin(4%,1/28),liver enzyme(22%,6/27)and muscle enzyme(15%,4/27)occurred in different proportions.Renal function and blood glucose were normal.There were abnormal chest CT changes in 14 cases,including 9 cases with patchy ground glass opacities and nodules,mostly located in the l

关 键 词：疾病特征 2019新型冠状病毒 儿童 

分 类 号：R72[医药卫生—儿科]