呼吸道合胞病毒感染肺炎患儿发生重症肺炎的影响因素  

Influencing factors of severe pneumonia in children with respiratory syncytial virus infection

作　　者：闫智慧 王亚坤[1] 董伟然 孙伟[1] 郑博娟[1] 田利远[1] Yan Zhihui;Wang Yakun;Dong Weiran;Sun Wei;Zheng Bojuan;Tian Liyuan(Department of Respiratory,Children′s Hospital of Hebei Province,Shijiazhuang 050000,China)

机构地区：[1]河北省儿童医院呼吸科,石家庄050000

出　　处：《中国医师杂志》2023年第1期56-60,共5页Journal of Chinese Physician

基　　金：河北省医学科学研究课题(20211376)。

摘　　要：目的探讨呼吸道合胞病毒(RSV)感染肺炎患儿发生重症肺炎的影响因素。方法采用回顾性病例对照研究,收集2017年10月至2020年10月河北省儿童医院收治的210例RSV感染肺炎患儿,其中发生重症肺炎的70例患儿纳入重症肺炎组,发生普通肺炎的140例患儿纳入普通肺炎组;比较两组患儿基线资料、相关实验室指标;采用logistic回归分析RSV感染肺炎患儿发生重症肺炎的影响因素。结果重症肺炎组患儿喘息、合并先天性心脏病、合并呼吸衰竭、合并心力衰竭、胸腔积液占比高于普通肺炎组,用力肺活量(FVC)、第1秒用力呼气容积(FEV1)低于普通肺炎组(均P<0.05);重症肺炎组患儿C反应蛋白(CRP)、CD8^(+)细胞、RSV载量、Beclin-1高于普通肺炎组,CD4+细胞、1,25-双羟维生素D[1,25-(OH)2D]水平低于普通肺炎组(均P<0.05);经治疗后重症肺炎患儿CRP、CD8^(+)细胞、Beclin-1水平低于治疗前,CD4+细胞、1,25-(OH)2D水平高于治疗前(均P<0.05);建立多元回归模型分析,结果显示,合并先天性心脏病、CRP水平高、CD8^(+)细胞高、RSV载量高、Beclin-1水平高是RSV感染肺炎患儿发生重症肺炎的危险因素(均OR>1,P<0.05),CD4+细胞高、1,25-(OH)2D水平高是其保护因素(均OR<1,P<0.05)。结论RSV感染肺炎患儿发生重症肺炎可能受合并先天性心脏病、CRP、CD4+细胞、CD8^(+)细胞、1,25-(OH)2D、RSV载量、Beclin-1水平的影响。Objective To explore the influencing factors of severe pneumonia in children with respiratory syncytial virus(RSV)infection.Methods A retrospective case-control study was used to collect 210 children with RSV infected pneumonia admitted to Hebei Children′s Hospital from October 2017 to October 2020.Among them,70 children with severe pneumonia were included in the severe pneumonia group,and 140 children with common pneumonia were included in the common pneumonia group;the baseline data and relevant laboratory indicators of the two groups were compared;Logistic regression was used to analyze the influencing factors of severe pneumonia in children infected with RSV.Results The proportions of wheezing,congenital heart disease,respiratory failure,heart failure and pleural effusion of children in severe pneumonia group were higher than those in common pneumonia group,and the forced vital capacity(FVC)and forced expiratory volume in the first second(FEV1)were lower than those in common pneumonia group(all P<0.05);the levels of C-reactive protein(CRP),CD8^(+)cells,RSV load and Beclin-1 in severe pneumonia group were higher than those in common pneumonia group,and the levels of CD4^(+)cells and 1,25-dihydroxyvitamin D[1,25-(OH)2D]were lower than those in common pneumonia group(all P<0.05).After treatment,the levels of CRP,CD8^(+)cells and Beclin-1 in children with severe pneumonia were lower than those before treatment,and the levels of CD4^(+)cells and 1,25-(OH)2D were higher than those before treatment(all P<0.05).Multiple regression model analysis was established.The results showed that congenital heart disease,high CRP level,high CD8^(+)cells,high RSV load and high Beclin-1 level were risk factors for severe pneumonia in children with RSV infected pneumonia(all OR>1,P<0.05),and high CD4^(+)cells and 1,25-(OH)2D level were protective factors(all OR<1,P<0.05).Conclusions Severe pneumonia in children with RSV infected pneumonia may be affected by congenital heart disease,CRP,CD4^(+)cells,CD8^(+)cells,1,25-(OH)2D,RSV lo

关 键 词：呼吸道合胞病毒 重症肺炎 C反应蛋白质 T淋巴细胞 

分 类 号：R725.6[医药卫生—儿科]