婴幼儿百日咳鲍特菌核酸载量与临床特征及病情严重程度的相关性研究  

Correlation between the nucleic acid load of Bordetella pertussis and clinical features and severity of illness in infants and young children with wooping cough

作　　者：邓永超 董彩霞 陈烁 莫丽亚 黄彩芝 Deng Yongchao;Dong Caixia;Chen Shuo;Mo Liya;Huang Caizhi(Department of Laboratory Medicine,The Affiliated Children′s Hospital of Xiangya School of Medcine,Central South University(Hunan Children′s Hospital),Changsha 410007,China;Department of Infectious Diseases,The Affiliated Children′s Hospital of Xiangya School of Medcine,Central South University(Hunan Children′s Hospital),Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)检验中心,长沙410007 [2]中南大学湘雅医学院附属儿童医院(湖南省儿童医院)感染科,长沙410007

出　　处：《中华预防医学杂志》2024年第10期1580-1586,共7页Chinese Journal of Preventive Medicine

基　　金：湖南省卫生健康委科研计划项目(D202306016859)。

摘　　要：本研究旨在探讨婴幼儿百日咳鲍特菌核酸(BP-DNA)载量与疾病临床特征的相关性,并探讨发生重症百日咳的危险因素。采用回顾性研究方法,选取2023年8月至2024年2月就诊于湖南省儿童医院且BP-DNA检测为阳性确诊为百日咳的1月龄~3岁婴幼儿作为分析对象,按BP-DNA的对数值(log10拷贝/ml)分为低载量组35例、中载量组78例和高载量组94例;按病情严重程度分为重症百日咳组54例和普通百日咳组153例。比较各组的临床特点及实验室检查数据,同时对重症百日咳发生的危险因素进行分析。运用受试者工作特征曲线(ROC)评价BP-DNA与白细胞(WBC)计数对发生重症百日咳的预测效能。结果显示,高载量组患儿WBC计数、淋巴细胞与中性粒细胞比值(L/N)、住院天数分别为22.59×10^(9)/L、3.31及9.0 d,均明显高于中载量组与低载量组(F=6.309、2.825、15.149,均P<0.05);住院治疗率、合并感染率、重症百日咳发生率、发热发生率及糖皮质激素使用率分别为100%、64.96%、31.9%、29.8%及57.4%,均明显高于其他两组(χ^(2)=25.977、9.163、9.371、8.299、20.332,均P<0.05);疫苗完全免疫率为9.6%,明显低于其他两组(χ^(2)=11.632,P<0.05)。与普通百日咳组相比,重症百日咳组<1岁患儿占比(100%,χ^(2)=9.581)、BP-DNA载量(6.56 Log10拷贝/ml,Z=4.004)、WBC计数(31.34×10^(9)/L,t=7.513,)、PCT水平(0.07 ng/ml,Z=2.626)、IL-6水平(6.65 ng/ml,Z=4.336)、合并感染率(88.9%,χ^(2)=36.536)、喘息或气促发生率(55.6%,χ^(2)=42.972)、就诊前使用大环内酯类药物症状无改善率(77.8%,χ^(2)=26.266)及发热发生率(55.6%,χ^(2)=42.972,)等指标均明显偏高,完全免疫率明显偏低(5.6%,χ^(2)=9.581),差异均有统计学意义(均P<0.05)。logistic回归分析结果显示高BP-DNA载量、高WBC计数、合并感染、喘息或气促、发热以及就诊前使用大环内酯类药物症状无改善是发生重症百日咳的危险因素,该回归模型预测重症百日�To study the correlation between the level of Bordetella pertussis nucleic acid and clinical features of the disease in infants and young children and to investigate the risk factors for the development of severe pertussis.Using retrospective research methods,children aged 1 month-3 years who came to Hunan Children′s Hospital from August 2023 to February 2024 and were diagnosed with pertussis for analysis.According to the logarithmic value of BP-DNA(log 10 copies/ml),35 cases were divided into the low load group,78 cases were divided into the medium load group and 94 cases were divided into the high load group;54 cases were divided into the severe whooping cough group and 153 cases were divided into the general group according to the severity of the disease;the clinical characteristics and laboratory data of the groups were compared,and the risk factors for the occurrence of severe whooping cough were analyzed at the same time.The ROC was used to evaluate the predictive efficacy of BP-DNA and WBC count for the development of severe pertussis.The results showed that in the high-dose group,the WBC count(22.59×10^(9)/L),L/N ratio(3.31),and hospitalization days(9.0 d)were significantly higher than those in the medium-dose group and low-dose group(F=6.309,2.825,15.149,all P<0.05).The hospitalization rate(100%),combined infection rate(64.96%),incidence of severe whooping cough(31.9%),pyrexia rate(29.8%),and corticosteroid use rate(57.4%)were also significantly higher than the other two groups(χ^(2)=25.977,9.163,9.371,8.299,20.332,all P<0.05),and the complete immunity rate(9.6%)was significantly lower than the other two groups(χ^(2)=11.632,P<0.05).Compared with the group of common whooping cough,the proportion of children under 1 year old(100%,χ^(2)=9.581),the BP-DNA load(6.56 log 10 copies/ml,Z=4.004),the WBC count(31.34×10^(9)/L,t=7.513),the PCT level(0.07 ng/ml,Z=2.626),the IL-6 level(6.65 ng/ml,Z=4.336),the combined infection rate(88.9%,χ^(2)=36.536),the incidence of wheezing or dyspnea(55.6%,χ^(2)=42.972),

关 键 词：百日咳鲍特菌 核酸 重症百日咳 危险因素 婴幼儿 

分 类 号：R725.1[医药卫生—儿科]