接种与未接种麻疹疫苗儿童麻疹的临床特征  

Clinical characteristics of measles in unvaccinated and vaccinated children

作　　者：苗敏 杨洪玲 刘洋 庞琳 Miao Min;Yang Honglin;Liu Yang;Pang Lin(Department of Pediatrics,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院儿科,北京100015

出　　处：《中华实验和临床感染病杂志（电子版）》2023年第2期110-116,共7页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：北京市医院管理局“扬帆”重点医学发展计划(No.ZYLX201602)。

摘　　要：目的探讨儿童接种麻疹疫苗与否对麻疹临床特征的影响。方法回顾性分析2009年3月至2019年7月首都医科大学附属北京地坛医院儿科收治的726例麻疹病例的临床资料:发病时间、性别、年龄、麻疹疫苗接种、临床表现、并发症、辅助检查及转归。根据是否接种麻疹疫苗将入组儿童分为未接种疫苗组(622例)和接种疫苗组(104例),采用Pearson卡方检验或连续校正卡方检验、秩和(Mann-Whitney U)检验比较两组患儿麻疹临床特征。结果726例患儿中男486例(66.9%)、女240例(33.1%),年龄[中位数(四分位数)]为8.6(6.6,11.9)个月,<1岁患儿最多(占73.1%)。未接种疫苗组622例(85.7%),<8个月患儿251例(40.4%);接种疫苗组104例(14.3%),无<8个月者。两组均以春季(3~5月份)为发病高峰。与接种疫苗组相比,未接种疫苗组患儿典型皮疹(67.0%vs.50.0%:χ^(2)=11.316、P=0.001)、麻疹黏膜斑(Koplik斑)(61.7%vs.38.5%:χ^(2)=19.868、P<0.001)、眼睑浮肿(22.5%vs.11.5%:χ^(2)=6.477、P=0.011)、结膜充血(45.0%vs.24.0%:χ^(2)=16.095、P<0.001)、眼分泌物(50.0%vs.30.8%:χ^(2)=13.221、P<0.001)、流泪(12.1%vs.3.8%:χ^(2)=6.196、P=0.013)、腹泻(29.3%vs.18.3%:χ^(2)=5.376、P=0.020)、咳嗽(77.2%vs.63.5%:χ^(2)=8.980、P=0.003)及呼吸道并发症喉炎(44.7%vs.26.9%:χ^(2)=11.541、P=0.001)、肺炎(80.4%vs.59.6%:χ^(2)=21.982、P<0.001)发生率均显著升高;而肝功异常发生率较低(12.1%vs.34.6%:χ^(2)=35.006、P<0.001),差异均有统计学意义。结论接种麻疹疫苗对儿童麻疹临床特征存在影响,未接种麻疹疫苗儿童感染后临床表现典型,呼吸道并发症较多;接种过麻疹疫苗的麻疹儿童患者临床表现不典型。未接种麻疹疫苗儿童是麻疹的主要感染人群,故需关注适龄婴幼儿麻疹疫苗接种及补充免疫接种。Objective To investigate the effect of measles vaccination on the clinical characteristics of measles in children.Methods Clinical data of 726 children with measles admitted to the Department of Pediatrics,BeijingDitan Hospital,Capital Medical University from March 2009 to July 2019 were analyzed,retrospectively,including onset time,gender,age,measles vaccination,clinical manifestations,complications,auxiliary examinations and prognosis.All children were grouped according to whether or not vaccinated against measles:the unvaccinated group(622 cases)and vaccinated group(104 cases),Chi-square test or continuously corrected Chi-square and rank sum(Mann-Whitney U)test were used to compare the clinical characteristics of measles between the two groups.Results Total of 726 children with measles were collected,including 486 boys(66.9%)and 240 girls(33.1%),the median age was[8.6(6.6,11.9)]months,among whom,children younger than one year old accounted for 73.1%.Total of 622 children(85.7%)were not vaccinated against measles,with 251(40.4%)children aged 0-8 months,and 104 children(14.3%)were vaccinated,without<8 months.The incidence peak was in spring(March to May)in both groups.For the cases in the vaccinated group,the incidence of typical rash(67.0%vs.50.0%:χ^(2)=11.316,P=0.001),measles mucosal plaque(Koplik plaque)(61.7%vs.38.5%:χ^(2)=19.868,P<0.001),eyelid edema(22.5%vs.11.5%:χ^(2)=6.477,P=0.011),conjunctival congestion(45.0%vs.24.0%:χ^(2)=16.095,P<0.001),eye secretions(50.0%vs.30.8%:χ^(2)=13.221,P<0.001),watery eyes(12.1%vs.3.8%:χ^(2)=6.196,P=0.013),diarrhea(29.3%vs.18.3%:χ^(2)=5.376,P=0.020),cough(77.2%vs.63.5%:χ^(2)=8.980,P=0.003)and respiratory complications laryngitis(44.7%vs.26.9%:χ^(2)=11.541,P=0.001)and pneumonia(80.4%vs.59.6%:χ^(2)=21.982,P<0.001)in the unvaccinated group were significantly higher;while the incidence of liver damage(12.1%vs.34.6%:χ^(2)=35.006,P<0.001)was significantly lower.Conclusions Measles vaccination has an effect on the clinical characteristics of children with measles.Childre

关 键 词：儿童 麻疹 麻疹疫苗 回顾性研究 

分 类 号：R725.1[医药卫生—儿科]