昆明地区新型冠状病毒Omicron变异株感染患儿的临床特征  

Clinical characteristics of children with SARS-CoV-2 Omicron variant infection in Kunming

作　　者：杨家武[1] 汤春辉[2] 戴梅[3] 段江[3] 李艳红[4] 杨剑 杨涛 高燕 班登 朱基财 袁廷运 李银 付红敏[1] Yang Jiawu;Tang Chunhui;Dai Mei;Duan Jiang;Li Yanhong;Yang Jian;Yang Tao;Gao Yan;Ban Deng;Zhu Jicai;Yuan Tingyun;Li Yin;Fu Hongmin(Department of Respiratory and Critical Care Medicine,Kunming Children′s Hospital,Yunnan Provincial Key Laboratory of Children′s Major Diseases Research,Kunming 650034,China;Department of Pediatrics,the First People′s Hospital of Yunnan Province,Kunming 650032,China;Department of Pediatrics,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;Department of Pediatrics,the Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China;Department of Pediatrics,Yan′an Hospital of Kunming,Kunming 650051,China;Department of Pediatrics,the People′s Hospital of Anning City,Kunming 650300,China)

机构地区：[1]昆明市儿童医院呼吸与危重症医学科云南省儿童重大疾病研究重点实验室,昆明650034 [2]云南省第一人民医院儿科,昆明650032 [3]昆明医科大学第一附属医院儿科,昆明650032 [4]昆明医科大学第二附属医院儿科,昆明650101 [5]昆明市延安医院儿科,昆明650051 [6]安宁市人民医院儿科,昆明650300

出　　处：《中华儿科杂志》2023年第10期922-927,共6页Chinese Journal of Pediatrics

摘　　要：目的了解新型冠状病毒疫情非药物性干预措施解除后,昆明地区新型冠状病毒Omicron变异株感染住院患儿的临床特点及重症患儿的危险因素分析。方法回顾性病例总结,分析2022年12月10日至2023年1月9日昆明市6家三甲医院1145例新型冠状病毒Omicron变异株感染的住院患儿的临床资料,根据临床严重程度将患儿分为普通组和重症组,比较两组患儿的临床及实验室资料。采用t检验、χ^(2)检验和Mann-Whitney U检验进行组间比较,采用Spearman相关性检验和多因素Logistic回归方法分析重症组的危险因素。结果1145例患儿中男677例、女468例,就诊年龄1.7(0.5,4.1)岁,≤3岁758例(66.2%),>3岁387例(33.8%)。有基础疾病89例(7.8%)、无基础疾病1056例(92.2%)。接种疫苗者(≥1剂)319例(27.9%),急性上呼吸道感染748例(65.3%),死亡6例(0.5%)。普通组1051例、重症组94例。重症组的接种疫苗的比例、就诊年龄、淋巴细胞计数和CD8+淋巴细胞比例均低于普通组[36例(38.3%)比283例(26.9%)、0.5(2.6,8.0)比1.6(0.5,3.9)岁、1.3(1.0,2.7)×109比2.7(1.3,4.4)×109/L、0.17(0.12,0.24)比0.21(0.15,0.16),χ^(2)=4.88、Z=-2.21、-5.03、-2.53,均P<0.05]。重症组的住院时间、有基础病的比例、丙氨酸转氨酶、天冬氨酸转氨酶、肌酸激酶同工酶、肌钙蛋白T水平均高于普通型组[(11.6±5.9)比(5.3±1.8)d、41例(43.6%)比48例(4.6%)、67(26,120)比20(15,32)U/L、51(33,123)比44(34,58)U/L、56.9(23.0,219.3)比3.6(1.9,17.9)U/L、12.0(4.9,56.5)×10^(-3)比3.0(3.0,7.0)×10^(-3)pg/L,t=-20.43,χ^(2)=183.52,Z=-9.14、-3.12、-6.38、-3.81,均P<0.05]。多因素Logistic回归分析示白细胞计数(OR=1.88,95%CI 1.18~2.97,P<0.01)、C反应蛋白(OR=1.18,95%CI 1.06~1.31,P<0.01)、铁蛋白(OR=1.01,95%CI 1.00~1.00,P<0.01)、白细胞介素6(OR=1.05,95%CI 1.01~1.08,P=0.012)、D二聚体(OR=2.56,95%CI 1.44~4.56,P<0.01)升高,CD4+淋巴细胞比例降低(OR=0.84,95%CI 0.73~0.98,P=0.030)均是住院患儿发生重症的危�ObjectiveTo investigate the clinical characteristics of hospitalized children infected with the Omicron variant in Kunming after the withdrawal of non-pharmaceutical interventions(NPI)and analyze the risk factors of severe cases.MethodsClinical data was retrospectively collected from 1145 children with SARS-CoV-2 Omicron infection who were hospitalized in six tertiary grade A hospitals in Kunming from December 10th,2022 to January 9th,2023.According to clinical severity,these patients were divided into the general and severe SARS-CoV-2 groups,and their clinical and laboratory data were compared.Between-group comparison was performed using t-test,chi-square test and Mann-Whitney U test.Spearman correlation test and multivariate Logistic regression analysis were used to determine the risk factors of severe illness.ResultsA total of 1145 hospitalized patients were included,of whom 677 were male and 468 female.The age of these patients at visit was 1.7(0.5,4.1)years.Specifically,there were 758 patients(66.2%)aged≤3 years at visit and 387 patients(33.8%)aged>3 years.Of these children,89 cases(7.8%)had underline diseases and the remaining 1056 cases(92.2%)had no combined diseases.Additionally,of all the patients,319 cases(27.9%)were vaccinated with one or two doses of SARS-CoV-2 vaccine,748 cases(65.3%)had acute upper respiratory tract infection(AURTI),and six cases died(0.5%).A total of 1051 cases(91.8%)were grouped into general SARS-CoV-2 group and 94 cases(8.2%)were grouped into severe SARS-CoV-2 group.Compared with the general cases,the severe cases showed a lower rate of SARS-CoV-2 vaccination and younger median age,lower lymphocyte count,as well as proportions of CD8+T lymphocyte(36 cases(38.3%)vs.283 cases(26.9%),0.5(2.6,8.0)vs.1.6(0.5,3.9)years,1.3(1.0,2.7)×109 vs.2.7(1.3,4.4)×109/L,0.17(0.12,0.24)vs.0.21(0.15,0.16),respectively,χ^(2)=4.88,Z=-2.21,-5.03,-2.53,all P<0.05).On the other hand,the length of hospital stay,proportion of underline diseases,ALT,AST,creatine kinase isoenzyme,and troponin T were high

关 键 词：儿童 感染 Omicron 非药物性干预措施 临床特征 

分 类 号：R725.1[医药卫生—儿科]