2022年广州地区家庭聚集性儿童新型冠状病毒Omicron变异株感染的临床特征  

Clinical characteristics of children with family clusters of SARS-CoV-2 Omicron variant infection in Guangzhou in 2022

作　　者：黄大彬 梁振宇[1] 张晓[1] 张志钢[1] 游楚明[1] 孟琼[1] HUANG Dabin;LIANG Zhenyu;ZHANG Xiao;ZHANG Zhigang;YOU Chuming;MENG Qiong(Department of Pediatrics,Guangdong Second Provincial General Hospital,Guangzhou 510317,China)

机构地区：[1]广东省第二人民医院儿科,广东广州510317

出　　处：《分子影像学杂志》2023年第5期924-929,共6页Journal of Molecular Imaging

摘　　要：目的探讨家庭聚集性儿童新型冠状病毒Omicron变异株感染的临床特征及影像学变化。方法将2022年10~12月在广东省第二人民医院收治的241例6岁以下确诊为新型冠状病毒Omicron变异株感染的儿童作为研究对象,根据感染年龄分为3组:0~1岁(n=76),1~3岁(n=80),3~6岁(n=85)。比较3组患儿的临床特征、实验室检查结果、疫苗接种史、影像学检查结果及转归。结果241例患儿中,轻型203例(84.2%),重型38例(15.8%),无中型及危重型。发热为主要症状(97.5%),其次是咳嗽(54.4%)、腹泻(29.9%)、鼻塞或流涕(25.7%)、惊厥(15.4%)。3~6岁的发热热程最低,核酸转阴时间最短,容易出现上呼吸道症状;0~1岁的发热热峰最低,以咳嗽、腹泻及皮疹为主要症状。0~1岁婴儿较年长儿容易出现肺炎性状的影像学表型,X线可表现为双肺野见斑片状和或云雾状阴影;胸部CT可表现为双肺纹理增粗,肺野通亮度减低,见条状和或片状高密度影,边界模糊。1~3岁重型发生率最高(22.5%),较0~1岁更容易发生惊厥。与轻型相比,重型的SARS-CoV-2 N基因循环阈值更低,更容易出现淋巴细胞计数减少、中性粒细胞与淋巴细胞计数比值升高及血清淀粉样蛋白A升高。在3~6岁患儿中,与接种0剂或1剂疫苗者相比,接种2剂疫苗的患儿发热热程超过2 d的风险更低(OR=0.373,95%CI:0.152~0.912,P=0.029),发生腹泻的风险降低(OR=0.298,95%CI:0.096~0.922,P=0.030),核酸转阴时间更短(OR=0.359,95%CI:0.149~0.867,P=0.021),重型的发生率降低17.3%(OR=0.237,95%CI:0.061~0.922,P=0.040)。结论家庭聚集性Omicron变异株感染儿童以发热、咳嗽为主要症状,胸部CT可呈现肺部炎性改变。1~3岁儿童较0~1岁更容易发生惊厥。中性粒细胞与淋巴细胞计数比值和血清淀粉样蛋白A有助于预测感染的严重程度。疫苗接种可降低3~6岁儿童发生重型的风险,降低病毒载量,减少核酸阳性持续时间。Objective To investigate the clinical characteristics and chest CT or X-ray features of family-clustered children infected with the Omicron variant of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Methods A retrospective analysis was performed on the medical data of 241 children with SARS-CoV-2 Omicron variant infection who were admitted to Guangdong Second Provincial General Hospital,the designated hospital for COVID-19 from October 2022 to December 2022.The children were divided into 76 cases of 0-1 year,80 cases of 1-3 years old and 85 cases of 3-6 years old according to the age of infection.The clinical characteristics,results of laboratory examination,chest CT or X-ray findings and outcome of the three groups were compared.Results Among 241 children,203 cases(84.2%)were mild,38 cases(15.8%)were severe,no moderate or critical.Fever was the most common symptom(97.5%),followed by cough(54.4%),diarrhea(29.9%),nasal congestion and/or runny nose(25.7%),and convulsion(15.4%).Children aged 3-6 years old were prone to upper respiratory symptoms,with the lowest fever duration and the shortest nucleic acid negative conversion time.Children aged 0-1 year mainly showed symptoms of cough,diarrhea and rash,with the lowest peak of fever.Infants aged 0-1 year were more likely to present radiological phenotype of pneumonia than older children.X-rays showed patchy and/or cloudy shadows in both lung fields,while chest CT showed thickened lung texture,decreased transparency of lung fields,and linear or patchy high-density shadows with blurred boundaries.Children aged 1-3 years old had the highest incidence of severe COVID-19 infection(22.5%),and they were more likely to have convulsions than those aged 0-1 year.Compared with mild cases,severe cases had lower cycle threshold value of SARS-CoV-2 N gene,lower lymphocyte count,higher neutrophil-to-lymphocyte ratio and higher serum amyloid A level.Among children aged 3-6 years,compared with those who received 0 or 1 dose of the vaccine,children who received 2 doses of t

关 键 词：新型冠状病毒 Omicron变异株 家庭聚集性 儿童 临床特征 

分 类 号：R725.6[医药卫生—儿科]