儿童呼吸道感染的临床特征、预后及其影响因素分析

王静; 章樱

doi:10.16766/j.cnki.issn.1674-4152.001778

儿童呼吸道感染的临床特征、预后及其影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.001778

王静,
章樱^,

浙江省人民医院(杭州医学院附属人民医院)儿科，浙江杭州 310014

基金项目:

浙江省医药卫生科技计划 2020KY025

详细信息

通讯作者:
章樱，E-mail: wqr78456@163.com

中图分类号: R725.6
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- 文章访问数: 209
- HTML全文浏览量: 107
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2020-10-11
- 网络出版日期: 2022-02-19

Clinical features, prognosis, and influencing factors of respiratory tract infection in children

WANG Jing,
ZHANG Ying^,

Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, China

摘要

摘要: 目的探讨儿童呼吸道感染的临床特征和主要致病菌，分析患儿预后情况及预后不良的相关因素。方法便利抽样法选择2018年1月—2019年12月在浙江省人民医院住院治疗的1 246例呼吸道感染患儿为研究对象，回顾性分析其呼吸道感染致病菌类型，统计儿童呼吸道感染的预后情况，采用多因素logistic回归分析统计儿童呼吸道感染预后不良的相关因素。结果 1 246例呼吸道感染患儿中有387例呼吸道病毒检出阳性，检出率为31.1%；检出病毒中以呼吸道合胞病毒(RSV)检出阳性例数最多，检出率为62.8%(243/387)，其次为A型流感病毒(Flu A)，检出率为22.5%(87/387)；经治疗后95.2%(1 186/1 246)的患儿好转，4.8%(60/1 246)的患儿预后不良。单因素分析显示：父母有过敏史、吸二手烟、无户外活动、春冬季和年龄在1岁以下的呼吸道感染患儿预后不良(P＜0.001)；多因素logistic分析结果显示：无户外活动、春冬季和年龄在1岁以下是患儿预后不良的危险因素(均P＜0.05)。结论儿童呼吸道感染主要致病菌为RSV，预后不良的患儿比例较高，且以冬春季为主，1岁以下患儿为易感人群，应在日常生活中增加户外活动、保障均衡饮食、提高患儿免疫功能。
- 儿童 /
- 呼吸道感染 /
- 临床特征 /
- 预后 /
- 影响因素
Abstract: Objective To explore the clinical characteristics and main pathogenic bacteria of respiratory tract infection in children, to analyse the prognosis and related factors of children with poor prognosis, and to provide clinical basis for good prognosis of children with respiratory tract infection. Methods From January 2018 to December 2019, 1 246 children with respiratory tract infection were selected as the subjects of study. The types of respiratory tract infection pathogens were retrospectively analysed, and the prognosis of children with respiratory tract infection was counted. Multivariate logistic regression analysis was used to determine the prognostic factors of children with respiratory tract infection. Results Amongst the 1 246 children with respiratory infections, 387 were positive for respiratory viruses, the incidence was 31.1%. Respiratory syncytial virus (RSV) was the highest number of positive cases, with a composition ratio of 62.8% (243/387), followed by Influenza A virus (Flu A), with a composition ratio of 22.5% (87/387). After treatment, 95.2% (1 186/1 246) of the children improved, the prognosis of 4.8% (60/1 246) children was poor. Univariate analysis showed statistically significant differences in the prognosis of children with allergic history, second-hand smoke, no outdoor activities, respiratory tract infections in spring, winter, and under one year of age (P < 0.001). Multivariate logistic analysis results showed that no outdoor activities, spring, winter, and age under 1 years were risk factors for poor prognosis (all P < 0.05). Conclusion RSV is the main pathogen of respiratory tract infection in children, and the proportion of children with poor prognosis is high, and mainly in winter and spring. Children under 1 year old are the susceptible population, and they should increase outdoor activities in daily life, ensure a balanced diet, and improve their immune function.
- Children /
- Respiratory tract infection /
- Clinical features /
- Prognosis /
- Influencing factors

HTML全文

表 1 呼吸道感染患儿致病菌检出情况

致病菌	菌株数	构成比(%)
呼吸道合胞病毒(RSV)	243	62.8
A型流感病毒(Flu A)	87	22.5
B型流感病毒(Flu B)	25	6.5
腺病毒病毒	11	2.8
副流感病毒1	8	2.1
副流感病毒2	6	1.6
副流感病毒3	7	1.8

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表 2 呼吸道感染患儿预后不良单因素分析(例)

临床特征	类别	例数	预后良好(n=1 186)	预后不良(n=60)	χ²值	P值
性别	男	688	656	32	0.090	0.764
	女	558	530	28
年龄(岁)	＜1	304	271	33	32.003	＜0.001
	≥1	942	915	27
父母有过敏史	有	255	223	32	41.836	＜0.001
	无	991	963	28
吸二手烟	有	306	280	26	11.993	＜0.001
	无	940	906	34
户外运动	有	781	761	20	23.209	＜0.001
	无	465	425	40
季节	春、冬季	804	753	51	11.543	＜0.001
	夏、秋季	442	433	9
病程时间(d)	＞7	672	641	31	0.130	0.718
	≤7	574	545	29
联合用药	是	792	755	37	0.098	0.754
	否	454	431	23
母乳喂养	是	850	808	42	0.092	0.761
	否	396	378	18

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表 3 自变量赋值

自变量	赋值
父母有过敏史	有=1，无=0
吸二手烟	是=1，否=0
无户外运动	是=1，否=0
春、冬季	是=1，否=0
年龄在1岁以下	是=1，否=0

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表 4 呼吸道感染患儿预后不良多因素分析

影响因素	B	SE	Wald χ²	P值	OR值	95% CI
父母有过敏史	0.271	0.256	0.891	0.480	0.734	0.261~0.984
吸二手烟	0.742	0.342	0.779	0.146	0.271	0.051~1.367
无户外活动	0.615	0.406	3.273	0.033	1.022	0.287~4.293
春、冬季	0.342	0.587	4.037	0.023	2.051	1.186~4.292
年龄在1岁以下	0.182	0.218	5.131	0.002	2.874	1.682~4.338
常数项	-0.571	0.261	5.823	0.029

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参考文献(17)

[1]	BRADY N C, ROMINE R E S, HOLBROOK A, et al. Measuring change in the communication skills of children with austim spectrum disorder using the communication complexity scale[J]. Am J Intellect Dev Disabil, 2020, 125(6): 481-492. doi: 10.1352/1944-7558-125.6.481
[2]	STENGELIN R, HEPACH R, HAUN D B M. Cultural variation in young children's social motivation for peer collaboration and its relation to the ontogeny of Theory of Mind[J]. PLoS One, 2020, 15(11): e0242071. doi: 10.1371/journal.pone.0242071
[3]	MILLER J E, GOLDACRE R, MOORE H C, et al. Mode of birth and risk of infection-related hospitalisation in childhood: A population cohort study of 7.17 million births from 4 high-income countries[J]. PLoS Med, 2020, 17(11): e1003429. doi: 10.1371/journal.pmed.1003429
[4]	LIU S, CHANG F C, CHIU C H, et al. Parent-Child Discrepancies in Reports of Exposure to Violence/Pornography on Mobile Devices and the Impact on Children's Psychosocial Adjustment[J]. Cyberpsychol Behav Soc Netw, 2020, 18(20): 225-227. http://www.researchgate.net/publication/347069556_Parent-Child_Discrepancies_in_Reports_of_Exposure_to_ViolencePornography_on_Mobile_Devices_and_the_Impact_on_Children's_Psychosocial_Adjustment
[5]	丁常聪, 金淑娟, 刘泉波. 儿童铜绿假单胞菌脓毒症的临床特征及预后相关因素分析[J]. 四川医学, 2020, 41(5): 497-501. https://www.cnki.com.cn/Article/CJFDTOTAL-SCYX202005015.htm
[6]	符垂师, 黄惠敏, 李国雄, 等. 儿童肺炎支原体肺炎治愈1年内发生反复呼吸道感染的相关因素研究[J]. 传染病信息, 2020, 33(2): 144-146, 175. https://www.cnki.com.cn/Article/CJFDTOTAL-CRBX202002011.htm
[7]	《诸福棠实用儿科学》第8版书讯[J]. 临床儿科杂志, 2015, 33(4): 308.
[8]	黄小兰, 贾楠, 肖飞, 等. 呼吸道病原体核酸双扩增法在儿童上呼吸道感染病原诊断中的应用研究[J]. 中华实验和临床病毒学杂志, 2020, 34(1): 57-58, 60.
[9]	中华医学会儿科学分会呼吸学组, 《中华儿科杂志》编辑委员会. 反复呼吸道感染的临床概念和处理原则[J]. 中华儿科杂志, 2008, 46(2): 108-110. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201762163.htm
[10]	刘菁. 儿童反复上呼吸道感染血清微量元素的缺乏情况及间断补锌、铁的防治效果分析[J]. 中国妇幼保健, 2019, 34(9): 2036-2038. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201909033.htm
[11]	龚如涵, 刘庆中, 陈沭, 等. 上海市松江区0~12岁上呼吸道感染患儿7种常见病毒流行病学特征[J]. 检验医学, 2019, 34(12): 1097-1100. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYY201912011.htm
[12]	叶青. 3~6岁儿童血清25羟维生素D水平与上呼吸道感染发生的相关性分析[J]. 中国妇幼保健, 2018, 33(12): 2725-2727. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201812030.htm
[13]	陈晓君, 郭瑞娟, 曾丽森. 影响3~6岁儿童反复发生上呼吸道感染的相关因素分析[J]. 中国儿童保健杂志, 2018, 26(11): 1244-1247. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201811023.htm
[14]	张凤, 史晓燕, 赵丹, 等. 2017-2018年青岛地区儿童急性上呼吸道感染病毒谱与流行特征[J]. 中华疾病控制杂志, 2019, 23(6): 694-699. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201906016.htm
[15]	MASCHAN A, PETROVA U, KALININA I, et al. Bortezomib induces long-term remission in children with immune thrombotic thrombocytopenic purpura, refractory to plasma exchange, glucocorticoids, and rituximab: A report on two cases[J]. Pediatr Blood Cancer, 2020, 19(12);e28818. doi: 10.1002/pbc.28818
[16]	CASASSA E, BERGERON A, MARUANI A, et al. Factors influencing quality of life in children with low-flow vascular malformations: a qualitative study using focus groups[J]. J Eur Acad Dermatol Venereol, 2020, 18(19): 2-8. doi: 10.1111/jdv.17037
[17]	SAWRIKAR V, DIAZ A M, TULLY L, et al. Bridging the gap between child mental health need and professional service utilisation: Examining the influence of mothers' parental attributions on professional help-seeking intentions[J]. Eur Child Adolesc Psychiatry, 2020, 23(16): 15-18. doi: 10.1007/s00787-020-01682-6