重症和危重症流行性感冒患儿的临床特点及其影响因素分析  

Clinical characteristics and risk factors of severe and critical influenza in children

作　　者：郑贵锋 温顺航[1] 陈小芳[1] 於梦菲 张海邻[1] Zheng Guifeng;Wen Shunhang;Chen Xiaofang;Yu Mengfei;Zhang Hailin(Department of Pediatric Pulmonology,Second Affiliated Hospital&Yuying Children′s Hospital,Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院(育英儿童医院)儿童呼吸科,325027

出　　处：《中华传染病杂志》2021年第5期285-288,共4页Chinese Journal of Infectious Diseases

摘　　要：目的探讨重症和危重症流行性感冒(以下简称流感)患儿的临床特点及其影响因素。方法回顾性分析2016年1月1日至2019年12月31日在温州医科大学附属第二医院(育英儿童医院)住院的214例重症和危重症流感患儿的临床资料,比较重症与危重症流感患儿的临床特征如年龄、性别、症状、体征、合并基础疾病、C反应蛋白(C-reactive protein,CRP)、临床转归等。统计学处理采用χ^(2)检验,采用logistic回归模型分析危重症流感相关的影响因素。结果214例患儿中,男153例(71.5%),年龄<5岁177例(82.7%),52例患儿合并基础疾病,207例有发热,54例出现惊厥,其中有3例为急性坏死性脑病,流感病毒以甲型为主[88.79%(190/214)]。危重症42例(19.6%),危重症流感患儿中合并基础疾病比例为61.9%(26/42),高于重症组的15.1%(26/172),差异有统计学意义(χ^(2)=40.175,P<0.01)。危重症流感患儿中CRP≥40 mg/L的比例为33.3%(14/42),高于重症组的9.3%(16/172),差异有统计学意义(χ^(2)=16.173,P<0.01)。多因素logistic回归分析显示,合并基础疾病[比值比(odds ratio,OR)=8.794,95%可信区间(confidence interval,CI)3.845~20.111]和CRP≥40 mg/L(OR=5.050,95%CI 1.966~12.970)是流感患儿发生危重症的影响因素。所有重症患儿均好转出院,42例危重症患儿中死亡7例。结论重症和危重症流感多发生于5岁以下患儿,合并基础疾病和CRP≥40 mg/L是发生危重症流感的影响因素。Objective To explore the clinical characteristics and risk factors of severe and critical influenza in children.Methods The clinical data of 214 inpatient children with severe and critical influenza hospitalized in the Second Affiliated Hospital&Yuying Children′s Hospital of Wenzhou Medical University from January 1,2016 to December 31,2019 were retrospectively collected.The clinical characteristics including age,gender,symptoms,signs,underlying diseases,C-reactive protein(CRP),treatment and outcome of children with severe and critical influenza were compared.Chi-Square test was used for statistical analysis.A binary logistic regression model was constructed to analyze the risk factors for critically ill influenza.Results Of the 214 children,153 were male(71.5%),177(82.7%)were under 5 years old.There were 52 children with underlying diseases.Fever occurred in 207 cases.Among the 54 cases that had convulsion during the course of the disease,three developed acute necrotizing encephalopathy.The influenza subtype was mainly type A,accounting for 190(88.79%).A total of 42(19.6%)children were critically ill.The incidence of critical influenza in children with underlying diseases(61.9%,26/42)was higher than that in severe influenza children(15.1%,26/172),and the difference was statistically significant(χ^(2)=40.175,P<0.01).The incidence of critical influenza in children with CRP≥40 mg/L was higher than that of severe influenza in children with CRP≥40 mg/L(33.3%(14/42)vs 9.3%(16/172)),and the difference was statistically significant(χ^(2)=16.173,P<0.01).Multivariate logistic regression showed that underlying diseases(odds ratio(OR)=8.794,95%confidence interval(CI)3.845-20.111)and CRP≥40 mg/L(OR=5.050,95%CI 1.966-12.970)were risk factors for critical influenza.All severe cases were improved and discharged.Among the 42 critically ill children,seven children died.Conclusions Among the severe and critical influenza in children,the majority of children are under five years old.Underlying diseases and CRP≥40 mg/L a

关 键 词：流感 人 危险因素 儿童 重症 临床特征 

分 类 号：R511.7[医药卫生—内科学]