新型冠状病毒大流行前后3月龄及以下呼吸道合胞病毒感染患儿的临床特点  

Clinical characteristics of infants with respiratory syncytial virus infection under 3 months of age before,during,and after the SARS-CoV-2 pandemic

作　　者：赵双葵 Abdullahi Abdihafid Mohamed 许燕萍[1] Zhao Shuangkui;Abdullahi Abdihafid Mohamed;Xu Yanping(Department of Neonatal Intensive Care Unit,Children′s Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,National Children's Regional Medical Center,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院新生儿重症监护中心、国家儿童健康与疾病临床医学研究中心、国家儿童区域医疗中心,杭州310052

出　　处：《中华儿科杂志》2025年第2期168-173,共6页Chinese Journal of Pediatrics

摘　　要：目的评估新型冠状病毒感染不同阶段下呼吸道感染(LRTI)住院的3月龄及以下患儿呼吸道合胞病毒(RSV)感染的流行病学和临床特征的变化。方法回顾性队列研究。收集2017年1月至2024年1月浙江大学医学院附属儿童医院LRTI住院的≤3月龄RSV阳性的3144例患儿的一般情况、实验室检查等临床资料。根据入院时间,将所有患儿分为新型冠状病毒感染前期、新型冠状病毒感染期间和新型冠状病毒感染后期3组,组间比较采用方差分析、χ^(2)检验、Kruskal Wallis秩和检验,评估新型冠状病毒感染对RSV流行病学和临床特征的影响。结果3144例RSV阳性的患儿中男1872例、女1272例,就诊年龄42(24,61)日龄。新型冠状病毒前期、期间及后期分别1224、1173和747例,3组在冬季、夏季和秋季RSV阳性率差异均有统计学意义(均P<0.001)。新型冠状病毒感染后期与新型冠状病毒感染前期和新型冠状病毒感染期间患儿相比,住院所需费用更高[8831.3(5925.0,12887.6)比7153.8(4918.0,9834.2)比7842.0(4920.0,11414.2)元,H=57.57,P<0.001],入院时血氧饱和度更低[0.95(0.94,0.97)比0.97(0.95,0.98)比0.97(0.95,0.98),H=143.96,P<0.001],静脉应用糖皮质激素[56.8%(424/747)比35.9%(439/1224)比29.9%(351/1173),χ^(2)=144.58,P<0.001]、应用免疫球蛋白[27.7%(207/747)比16.2%(198/1224)比14.6%(171/1173),χ^(2)=58.41,P<0.001]、呼吸支持[45.5%(340/747)比38.9%(476/1224)比36.7%(431/1173),χ^(2)=15.03,P=0.001]以及入住重症监护病房的比例均更高[3.9%(29/747)比1.3%(16/1224)比3.0%(35/1173),χ^(2)=13.86,P=0.001]。结论在新型冠状病毒感染后期,RSV出现了非季节性暴发,高峰期出现在夏季和秋季。新型冠状病毒感染后期RSV阳性患儿入院时氧饱和度更低,静脉应用糖皮质激素、免疫球蛋白应用、呼吸支持以及入住重症监护病房的比例更高。Objectives To assess the changes in epidemiologic and clinical characteristics of respiratory syncytial virus(RSV)infection among inpatient under 3 months of age with lower respiratory tract infection(LRTI)in different stages of the SARS-CoV-2 pandemic.Methods A retrospective cohort study was conducted.Clinical data on general condition and laboratory tests were collected from 3144 RSV-positive LRTI infants less than 3 months of age hospitalized at Children′s Hospital,Zhejiang University School of Medicine from January 2017 to January 2024.Based on the admission date,all patients were categorized into three groups:pre-SARS-CoV-2 infection,during SARS-CoV-2 infection and after SARS-CoV-2 infection.Clinical data from three groups of patients were compared using ANOVA or chi-square test or Kruskal Wallis text to assess the impact of the SARS-CoV-2 infection on the epidemiological and clinical characteristics of RSV.Results Among the 3144 RSV-positive children,there were 1872 males and 1272 females,with an age of 42(24,61)d.The pre-SARS-CoV-2 infection,during SARS-CoV-2 infection and after SARS-CoV-2 infection in 1224,1173 and 747 cases respectively.There were statistically significant differences in RSV infection in winter,summer and autumn(all P<0.001).Compared with the pre-SARS-CoV-2 pandemic and during the SARS-CoV-2 pandemic,children with RSV infection in the post-SARS-CoV-2 pandemic had higher hospitalization costs(8831.3(5925.0,12887.6)vs.7153.8(4918.0,9834.2)vs.7842.0(4920.0,11414.2)yuan,H=57.57,P<0.001),lower admission oxygen saturation(0.95(0.94,0.97)vs.0.97(0.95,0.98)vs.0.97(0.95,0.98),H=143.96,P<0.001),an increased rate of intravenous glucocorticosteroid application(56.8%(424/747)vs.35.9%(439/1224)vs.29.9%(351/1173),χ^(2)=144.58,P<0.001),immunoglobulin application(27.7%(207/747)vs.16.2%(198/1224)vs.14.6%(171/1173),χ^(2)=58.41,P<0.001),respiratory support(45.5%(340/747)vs.38.9%(476/1224)vs.36.7%(431/1173),χ^(2)=15.03,P=0.001),and intensive care unit admission(3.9%(29/747)vs.1.3%(16/1224)vs.3.0%(35/117

关 键 词：呼吸道合胞病毒 婴儿 新型冠状病毒感染 流行病学 临床特征 

分 类 号：R725.1[医药卫生—儿科]