Analysis of clinical characteristics and influencing factors of respiratory syncytial virus infection among children under 5 years old in Suzhou
REN Shao-long and SHAO Xue-jun contributed equally to this article
More Information
-
摘要:
目的 分析呼吸道合胞病毒(respiratory syncytial virus, RSV)感染住院儿童的临床特征，探究其影响因素。 方法 通过医院信息系统筛选2010-2014年期间于苏州大学附属儿童医院住院的5岁以下急性下呼吸道感染(acute lower respiratory infection, ALRI)病例，从病历中收集ALRI住院病例的临床诊治、生化检测资料，通过实验室检测信息系统获取其RSV检测结果。比较RSV阳性和阴性ALRI病例的临床特点，采用非条件Logistic回归分析模型分析RSV感染的影响因素。 结果 19 257名ALRI病例中，4 096例RSV检测结果阳性，阳性率为21.3%。RSV阳性ALRI患儿的常见症状为咳嗽(99.4%)、咽痛/咽红(98.3%)、喘息(60.9%)。与RSV阴性患儿相比，RSV阳性患儿喘息、气促发生率均较高(均有P＜0.001)，发热率低(χ2 =280.8，P＜0.001)。低年龄是RSV感染的独立危险因素，与24~＜60月龄儿童相比，1~＜6月龄、6~＜12月龄、12~＜24月龄儿童感染RSV的调整比值比分别为4.00(95% CI: 3.57~4.48)、2.60(95% CI: 2.30~2.94)、1.82(95% CI: 1.59~2.07)。 结论 RSV感染患儿喘息、气促的发生率较高；低年龄是RSV感染的独立危险因素，年龄越小，感染RSV的风险越高。 Abstract:Objective To analyze the clinical characteristics of hospitalized children with respiratory syncytial virus (RSV) infection and explore the influencing factors in RSV infection. Methods First of all, the Hospitalization Information System was applied to retrospectively screened the children with acute lower respiratory infection (ALRI) who got hospitalized in Suzhou University Affiliated Children's hospital (SCH) from 2010 to 2014. Then, the detailed data in relation to their clinical diagnosis, treatment and biochemical test was collected from the medical records of ALRI inpatient and the results of their RSV tests were obtained from the Laboratory Information System. Upon a comparison drawn in clinical characteristics between RSV positive and negative ALRI cases, non-conditional Logistic regression model analysis was performed to analyze the influencing factors in RSV infection. Results Among the 19 257 ALRI cases involved, 4 096 were positive for RSV, with a positive rate of 21.3%. The common symptoms exhibited by RSV-infected children include coughing (99.4%), sore throat (98.3%) and wheezing (60.9%). Compared with RSV-negative patients, RSV-positive ALRI patients had higher symptom rates in respect of wheezing and shortness of breath (all P < 0.001), but lower symptom rates with regard to fever (χ2 =280.8, P < 0.001). Young age was identified as an independent risk factor of RSV infection. In comparison with those children aged 24- < 60 months, the adjusted odds ratio for RSV infection among the children aged 1- < 6, 6- < 12, and 12- < 24 months reached 4.00 (95% CI: 3.57-4.48), 2.60 (95% CI: 2.30-2.94) and 1.82 (95% CI: 1.59-2.07), respectively. Conclusions The children with RSV infection have higher symptom rates of wheezing and shortness of breath. Young age is an independent risk factor for RSV infection, which means the younger the age, the higher the risk of RSV infection. -
图 1 按年龄段分层的RSV感染影响因素分析
Figure 1. Analysis of factors affecting RSV infection stratified by age group
表 1 19 257名ALRI住院儿童的基本特征[n(%)]
Table 1. Basic characteristics of 19 257 hospitalized ALRI children with RSV infection [n(%)]
变量 ALRI病例 RSV阳性 χ2值 P值 性别 6.0 0.015 男 12 171(63.2) 2656(21.8) 女 7 086(36.8) 1440(20.3) 月龄 754.1 < 0.001 1~＜6 6 817(35.4) 2 088(30.6) 6~＜12 4 187(21.7) 935(22.3) 12~＜24 3 801(19.7) 635(16.7) 24~＜60 4 452(23.1) 438(9.8) 医疗保险 59.1 < 0.001 有 8 623(44.8) 1617(18.8) 无 10 634(55.2) 2479(23.3) 早产a 3.5 0.062 是 1 227(6.5) 287(23.4) 否 17 736(93.5) 3749(21.1) 先天性心脏病b 7.4 0.007 有 727(3.8) 184(25.3) 无 18 519(96.2) 3 909(21.1) 合计 19 257(100.0) 4 096(21.3) 注: a早产指胎龄＜37周，有294(3.1%)个缺失值; b有无先天性心脏病有11(0.1%)个缺失值。 
下载: 导出CSV
表 2 RSV阳性与阴性ALRI住院病例的临床特征比较[n(%)]
Table 2. Comparison of clinical characteristics between RSV positive and negative ALRI inpatients [n(%)]
变量 RSV阳性病例(n=4 096) RSV阴性病例(n=15 161) χ2值 P值 临床症状 发热(腋温＞38℃) 1 563(38.8) 8 079(53.7) 280.8 < 0.001 最高腋温(℃) 38.9±1.0 a 39.0±0.7 a < 0.001 b 入院前发热天数 3(1, 4) c 3(2, 6) c < 0.001 d 咳嗽 4 001(99.4) 14 587(97.0) 76.5 < 0.001 咽痛/咽红 3 957(98.3) 14 674(97.6) 8.1 0.004 流涕 1 610(40.0) 5 256(34.9) 35.3 < 0.001 气促 608(15.1) 1 291(8.6) 150.7 < 0.001 喘息 2 452(60.9) 5 572(37.0) 742.7 < 0.001 呕吐 444(11.1) 1 708(11.4) 0.3 0.564 肺部听诊 异常呼吸音 1 724(43.3) 6 053(42.3) 1.3 0.248 干啰音 347(8.7) 1 101(7.7) 4.5 0.034 湿啰音 2 239(56.3) 6 832(47.8) 90.5 < 0.001 痰鸣音 1 200(30.2) 4 520(31.6) 3.0 0.085 喘鸣音 2 228(56.0) 5 033(35.2) 563.8 < 0.001 生化指标e 白细胞计数偏高 804(19.9) 4 105(27.6) 97.4 < 0.001 白细胞计数偏低 373(9.2) 1 183(7.9) 7.0 0.008 C反应蛋白偏高 518(12.9) 3 416(22.9) 195.3 < 0.001 治疗措施 吸氧治疗 532(13.2) 875(5.8) 254.5 < 0.001 收治ICU 195(4.9) 342(2.3) 76.8 < 0.001 住院天数[M(P25, P75)] 8(7, 9) c 7(6, 9) c < 0.001 d 注: 部分变量存在缺失值，肺部听诊缺失率为4.2%，其余变量缺失率在1%以下，计算症状发生率时已去除缺失值。a x±s；b t检验；c M(P25, P75)；d Mann-Whitney U检验；e白细胞计数偏高指计数>12×109 /L，偏低指计数 < 5×109 /L，C反应蛋白偏高指>10 mg/L。
下载: 导出CSV
表 3 分年龄段RSV阳性与阴性ALRI住院病例发热率比较
Table 3. Comparison of fever rate between RSV positive and negative ALRI inpatients by age group
月龄 发热病例数/病例数(%) χ2值 P值 全部ALRI病例 RSV阳性 RSV阴性 1~＜6 1 347/6 712(20.1) 312/2 043(15.3) 1 035/4 669(22.2) 42.1 < 0.001 6~＜12 2 186/4 146(52.7) 447/918(48.7) 1 739/3 228(53.9) 7.7 0.006 12~＜24 2 593/3 780(68.6) 447/629(71.1) 2 146/3 151(68.1) 2.1 0.144 24~＜60 3 516/4 432(79.3) 357/435(82.1) 3 159/3 997(79.0) 2.2 0.138 合计 9 642/19 070(50.5) 1 563/4 025(38.8) 8 079/15 045(53.7) 280.8 < 0.001
下载: 导出CSV
表 4 RSV感染影响因素的Logistic回归分析模型分析
Table 4. Logistic regression model analysis of factors affecting RSV infection
变量 RSV阳性[n(%)] RSV阴性[n(%)] 单因素分析OR(95% CI)值 P值 多因素分析OR(95% CI)值 P值 性别 男 2 656(21.8) 9 515(78.2) 1.09(1.02~1.18) 0.014 1.03(0.95~1.10) 0.522 女 1 440(20.3) 5 646(79.7) 1.00 1.00 月龄 1~＜6 2 088(30.6) 4 729(69.4) 4.05(3.62~4.52) < 0.001 4.00(3.57~4.48) < 0.001 6~＜12 935(22.3) 3 252(77.7) 2.64(2.33~2.98) < 0.001 2.60(2.30~2.94) < 0.001 12~＜24 635(16.7) 3 166(83.3) 1.84(1.61~2.09) < 0.001 1.82(1.59~2.07) < 0.001 24~＜60 438(9.8) 4 014(90.2) 1.00 1.00 早产 是 287(23.4) 940(76.6) 1.14(0.99~1.31) 0.062 1.01(0.88~1.16) 0.869 否 3 749(21.1) 13 987(78.9) 1.00 1.00 先天性心脏病 有 184(25.3) 543(74.7) 1.27(1.07~1.50) 0.007 0.99(0.83~1.18) 0.876 无 3 909(21.1) 14 610(78.9) 1.00 1.00 医疗保险 有 1 617(18.8) 7 006(81.2) 0.76(0.71~0.82) < 0.001 0.93(0.87~1.01) 0.071 无 2 479(23.3) 8 155(76.7) 1.00 1.00
下载: 导出CSV
-
[1] Rudan I, O'Brien KL, Nair H, et al. Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries[J]. J Glob Health, 2013, 3(1): 010401. DOI: 10.7189/jogh.03.010401. [2] McAllister D A, Liu L, Shi T, et al. Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis[J]. Lancet Glob Health, 2019, 7(1): e47-e57. DOI: 10.1016/S2214-109X(18)30408-X. [3] Nair H, Nokes DJ, Gessner BD, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis[J]. Lancet, 2010, 375(9725): 1545-1555. DOI: 10.1016/S0140-6736(10)60206-1. [4] Shi T, McAllister D A, O'Brien K L, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study[J]. Lancet, 2017, 390(10098): 946-958. DOI: 10.1016/S0140-6736(17)30938-8. [5] 尚莹, 可秋萍, 娄莹, 等. 呼吸道合胞病毒感染患儿临床及细胞因子特点[J]. 中华医院感染学杂志, 2020, 30(18): 2839-2842. DOI: 10.11816/cn.ni.2020-192393.Shang Y, Ke QP, Lou Y, et al. Clinical characteristics of children with respiratory syncytial virus infection and changes in cytokines[J]. Chin J Nosocomiology, 2020, 30(18): 2839-2842. DOI: 10.11816/cn.ni.2020-192393. [6] 米沛明, 汤美芬, 黄家宜, 等. 842例儿童呼吸道合胞病毒肺炎的临床分析[J]. 中国当代医药, 2019, 26(21): 45-48. DOI: 10.3969/j.issn.1674-4721.2019.21.014.Mi PM, Tang MF, Huang JY, et al. Clinical analysis of 842 children with Respiratory Syncytial Virus pneumonia[J]. China Mod Med, 2019, 26(21): 45-48. DOI: 10.3969/j.issn.1674-4721.2019.21.014. [7] Kawakami C, Sato A, Sumita H, et al. Fever responses are enhanced with advancing age during respiratory syncytial virus Infection among children under 24 months old[J]. Tohoku J Exp Med, 2018, 245(3): 217-222. DOI: 10.1620/tjem.245.217. [8] Arruvito L, Raiden S, Geffner J. Host response to respiratory syncytial virus infection[J]. Curr Opin Infect Dis, 2015, 28(3): 259-266. DOI: 10.1097/QCO.0000000000000159. [9] Goenka A, Kollmann T R. Development of immunity in early life[J]. J Infect, 2015, 71(1): S112-S120. DOI: 10.1016/j.jinf.2015.04.027. [10] 李欢欢, 程伟, 刘社兰, 等. 呼吸道合胞病毒监测体系现状及展望[J]. 预防医学, 2019, 31(4): 359-362. DOI:10.19485/j.cnki.issn2096- 5087.2019.04.008.LI HH, Cheng W, Liu SL, et al. Current situation and prospect of respiratory syncytial virus surveillance system[J]. Prev Med, 2019, 31(4): 359-362. DOI: 10.19485/j.cnki.issn2096-5087.2019.04.008. [11] Huang Y, Hua J, Wang D, et al. Risk factors of respiratory syncytial virus infection among pediatric influenza-like illness and severe acute respiratory infections in Suzhou, China[J]. J Med Virol, 2018, 90(3): 397-404. DOI: 10.1002/jmv.24961. [12] izci Güllü E, Akin Y, Karaaslan A, et al. RSV infection in Istanbul: risk factors and frequency[J]. J Infect Dev Ctries, 2017, 11(9): 691-696. DOI: 10.3855/jidc.8871. [13] Murray J, Bottle A, Sharland M, et al. Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study[J]. PLoS One, 2014, 9(2): e89186. DOI: 10.1371/journal.pone.0089186. [14] 张晓波, 刘丽娟, 施鹏, 等. 婴儿急性下呼吸道呼吸道合胞病毒感染的危险因素研究[J]. 中华儿科杂志, 2014, 52(5): 373-377. DOI: 10.3760/cma.j.issn.0578-1310.2014.05.012.Zhang XB, Liu LJ, Shi P, et al. Risk factors for acute respiratory syncytial virus infection of lower respiratory tract in hospitalized infants[J]. Chin J Pediatr, 2014, 52(5): 373-377. DOI: 10.3760/cma.j.issn.0578-1310.2014.05.012. [15] 周景兴, 薛雄豪, 朱翠清. 婴儿呼吸道合胞病毒急性下呼吸道感染的危险因素[J]. 儿科药学杂志, 2017, 23(11): 28-30. DOI: 10.13407/j.cnki.jpp.1672-108X.2017.11.010.Zhou JX, Xue XH, Zhu CQ. Risk factors of acute lower respiratory tract infection in infants with respiratory syncytial virus[J]. J Pediatr Pharm, 2017, 23(11): 28-30. DOI: 10.13407/j.cnki.jpp.1672-108X.2017.11.010. [16] 王瑾. 婴儿呼吸道合胞病毒急性下呼吸道感染的相关因素分析[J]. 中国妇幼健康研究, 2014, 25(5): 780-783. DOI: 10.3969/j.issn.1673-5293.2014.05.024.Wang J. Related factors of acute lower respiratory tract infection with respiratory syncytial virus[J]. Chin J Matern Child Heal Res, 2014, 25(5): 780-783. DOI: 10.3969/j.issn.1673-5293.2014.05.024. -
点击查看大图
图(1) / 表(4)
计量
- 文章访问数: 460
- HTML全文浏览量: 242
- PDF下载量: 64
- 被引次数: 0