儿童百日咳疑似病例400例临床特征分析  

Analysis of the clinical features of 400 suspected cases of pediatric pertussis

作　　者：黄辉[1] 邓莉[1] 张榕 肖飞[2] 邓洁[3] 杨健[4] Huang Hui;Deng Li;Zhang Rong;Xiao Fei;Deng Jie;Yang Jian(Department of Infectious Diseases,Children′s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;Central Laboratory,Capital Institute of Pediatrics,Beijing 100020,China;Laboratory of Virology,Capital Institute of Pediatrics,Beijing Key Laboratory of Etiology of Viral Disease in Children,Beijing 100020,China;Department of Neurology,Children′s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院感染科,北京100020 [2]首都儿科研究所实验中心,北京100020 [3]首都儿科研究所病毒研究室,儿童病毒病病原学北京市重点实验室,北京100020 [4]首都儿科研究所附属儿童医院神经内科,北京100020

出　　处：《中华实用儿科临床杂志》2021年第16期1245-1248,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的总结儿童百日咳疑似病例,了解其病原,分析儿童百日咳临床特点。方法采用回顾性研究方法,对2015年6月至2019年5月在首都儿科研究所附属儿童医院感染科就诊的百日咳疑似病例临床资料进行分析。结果1.400例百日咳疑似病例完成呼吸道分泌物百日咳杆菌核酸检测,检测阳性198例(49.5%)。2.百日咳以<1岁患儿为主要发病年龄(158/198例,79.8%),有咳嗽患者密切接触史113例(113/198例,57.1%),未接种或未完成全程百白破疫苗接种共162例(162/198例,81.8%)。痉挛性咳嗽发生率73.7%(146/198例),发病至确诊病程为(17.2±12.3)d,咳嗽后发绀31.3%(62/198例),咳嗽伴呕吐17.7%(35/198例),吸气性吼声12.1%(24/198例),其他伴随症状有喘息、流涕、发热、腹泻等。3.病例分为百日咳杆菌核酸检测阳性组(198例)、其他病原组(104例)、病原未明组(98例),3组临床症状比较显示,百日咳杆菌核酸检测阳性组咳嗽后发绀发生率最高(χ^(2)=15.334,P<0.001),其他病原组喘息、呼吸困难、发热、肺部啰音、喘鸣音发生率最高(χ^(2)=79.208、38.214、16.709、44.794、42.480,均P<0.001)。百日咳杆菌核酸检测阳性组血白细胞、淋巴细胞比例及血小板均高于其他2组(F=15.812、18.198、10.819,均P<0.001)。结论儿童百日咳疑似病例感染病原多样,完善百日咳杆菌核酸检测及呼吸道病毒检测有助于明确诊断。儿童百日咳以1岁以下婴儿、未完成疫苗接种者更为常见,临床症状以痉挛性咳嗽最突出,与其他病原感染相比,咳嗽后发绀症状发生率更高。Objective To summarize the suspected cases of pertussis,to explore the pathogen,and to analyze the clinical features of pertussis.Methods A retrospective study was conducted to analyze the clinical data of suspected pertussis cases who visited the Department of Infectious Diseases in the Children′s Hospital Affiliated to Capital Institute of Pediatrics from June 2015 to May 2019.Results(1)The PCR test for respiratory secretions of Bacillus pertussis was completed in 400 cases,with 198 cases positive(49.5%).(2)Among the 198 cases,158 cases with pertussis were less than 1 year old(79.8%),113 cases had a clear history of close contact with cough patients(57.1%),and 162 cases were not vaccinated or did not complete full diphtheria and tetanus toxoids and pertussis(DTP)vaccination(81.8%).The incidence of spasmodic cough was 73.7%(146/198 cases);the duration from onset to diagnosis was(17.2±12.3)d;the incidence of cyanosis after cough was 31.3%(62/198 cases),cough with vomiting 17.7%(35/198 cases),inspiratory croup 12.1%(24/198 cases);other concomitant symptoms included wheezing,runny nose,fever,diarrhea,etc.(3)All the patients were divided into the pertussis group(198 cases),other pathogen group(104 cases),and unknown pathogen group(98 cases).Comparison of the clinical symptoms of the three groups showed the highest incidence of cyanosis after cough in pertussis group(χ2=15.334,P<0.001),and the highest incidence of wheezing,dyspnea,fever,pulmonary rales and stridor in other pathogen group(χ2=79.208,38.214,16.709,44.794,42.480,all P<0.001).The percentages of white blood cells,lymphocytes and platelets in the pertussis group were higher than those in the other two groups(F=15.812,18.198,10.819,all P<0.001).Conclusions Suspected cases of pertussis are infected with various pathogens.Improving the pertussis nucleic acid detection and respiratory virus detection can help to make a clear diagnosis.Pertussis is more common in infants under 1 year of age and in those who have not completed vaccination.The most prominent

关 键 词：百日咳 荧光定量聚合酶链反应 痉挛性咳嗽 儿童 呼吸道病毒 

分 类 号：R725.1[医药卫生—儿科]