目的 探讨不同年龄儿童Omicron变异株流行期间新型冠状病毒感染（coronavirus disease 2019，COVID-19）临床特征的差异。 方法 回顾性分析2022年12月9日—2023年1月8日于广东省中山市人民医院普通儿科住院确诊为COVID-19的211例患儿的临床资料，根据年龄分为1个月~<1岁组（84例）、1~<3岁组（64例）、3~<5岁组（29例）和≥5岁组（34例），分析比较不同年龄段儿童的一般情况、临床特征、实验室结果、诊治及转归的差异。 结果 3岁以下儿童占COVID-19住院儿童70.1%（148/211），3~<5岁组、≥5岁组患儿合并基础疾病比例高于1个月~<1岁组和1~<3岁组（P<0.05）。与其他3组相比，1个月~<1岁组患儿呼吸困难、鼻塞/鼻涕、腹泻的比例更高，惊厥发作及神经系统受累比例更低（P<0.05）。并且，与其他3组相比，1个月~<1岁组患儿胆汁酸及肌酸激酶同工酶升高比例更高，血小板计数降低、中性粒细胞比例升高及淋巴细胞比例降低比例更低（P<0.05）。COVID-19分型上，1个月~<1岁组患儿轻型比例高于1~<3岁组，重型/危重型比例低于其他3组（P<0.05）。1个月~<1岁组患儿吸氧比例高于其他3组（P<0.05）。 结论 不同年龄组儿童Omicron变异株流行期间COVID-19临床特征不同，尤其是1个月~<1岁与≥1岁患儿之间差异更明显。
Abstract
Objective To study the differences in the clinical features of children with coronavirus disease 2019 (COVID-19) in different age groups during the epidemic of Omicron variant. Methods A retrospective analysis was performed on the clinical data of 211 children with COVID-19 who were admitted to the Department of General Pediatrics, Zhongshan People's Hospital, from December 9, 2022 to January 8, 2023. According to their age, they were divided into 4 groups: 1 month-<1 year (n=84), 1-<3 years group (n=64), 3-<5 years (n=29), and ≥5 years (n=34). The above groups were compared in terms of general status, clinical features, ancillary examination results, treatment, and outcome. Results The children aged <3 years accounted for 70.1% (148/211) of all hospitalized children with COVID-19, and the 3-<5 years group and the ≥5 years group had a significantly higher proportion of children with underlying diseases than the 1 month-<1 year group and the 1-<3 years group (P<0.05). Compared with the other three groups, the 1 month-<1 year group had significantly higher incidence rates of dyspnea, nasal congestion/nasal discharge, diarrhea and significantly lower incidence rates of convulsion and nervous system involvement (P<0.05). Moreover, compared with the other three groups, the 1 month-<1 year group had significantly higher incidence rates of increases in bile acid and creatine kinase isoenzyme and significantly lower incidence rates of decreased platelet count, increased neutrophil percentage, and decreased lymphocyte percentage (P<0.05). The 1 month-<1 year group had a significantly higher incidence rate of mild COVID-19 than the 1-<3 years group and a significantly lower incidence rate of severe/critical COVID-19 than the other three groups (P<0.05). Compared with the other three groups, the 1 month-<1 year group had a significantly higher proportion of children receiving oxygen inhalation therapy (P<0.05). Conclusions Children with COVID-19 in different age groups have different clinical features during the epidemic of Omicron variant, especially between the children aged 1 month to <1 year and those aged ≥1 year.
关键词
新型冠状病毒感染 /
Omicron变异株 /
临床特征 /
年龄组 /
儿童
Key words
Coronavirus disease 2019 /
Omicron variant /
Clinical feature /
Age group /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Menni C, Valdes AM, Polidori L, et al. Symptom prevalence, duration, and risk of hospital admission in individuals infected with SARS-CoV-2 during periods of Omicron and Delta variant dominance: a prospective observational study from the ZOE COVID Study[J]. Lancet, 2022, 399(10335): 1618-1624. PMID: 35397851. PMCID: PMC8989396. DOI: 10.1016/S0140-6736(22)00327-0.
2 Butt AA, Dargham SR, Loka S, et al. Coronavirus disease 2019 disease severity in children infected with the Omicron variant[J]. Clin Infect Dis, 2022, 75(1): e361-e367. PMID: 35404391. PMCID: PMC9047187. DOI: 10.1093/cid/ciac275.
3 O'Driscoll M, Ribeiro Dos Santos G, Wang L, et al. Age-specific mortality and immunity patterns of SARS-CoV-2[J]. Nature, 2021, 590(7844): 140-145. PMID: 33137809. DOI: 10.1038/s41586-020-2918-0.
4 Akbar AN, Gilroy DW. Aging immunity may exacerbate COVID-19[J]. Science, 2020, 369(6501): 256-257. PMID: 32675364. DOI: 10.1126/science.abb0762.
5 Pokorska-?piewak M, Talarek E, Mania A, et al. Clinical and epidemiological characteristics of 1283 pediatric patients with coronavirus disease 2019 during the first and second waves of the pandemic-results of the pediatric part of a multicenter Polish register SARSTer[J]. J Clin Med, 2021, 10(21): 5098. PMID: 34768620. PMCID: PMC8585006. DOI: 10.3390/jcm10215098.
6 Preston LE, Chevinsky JR, Kompaniyets L, et al. Characteristics and disease severity of US children and adolescents diagnosed with COVID-19[J]. JAMA Netw Open, 2021, 4(4): e215298. PMID: 33835179. PMCID: PMC8035649. DOI: 10.1001/jamanetworkopen.2021.5298.
7 蒋荣猛, 谢正德, 姜毅, 等. 儿童新型冠状病毒感染诊断、治疗和预防专家共识(第五版)——应对奥密克戎变异株[J]. 中华实用儿科临床杂志, 2023, 38(1): 20-30. DOI: 10.3760/cma.j.cn101070-20230114-00036.
8 中华人民共和国国家卫生健康委员会. 儿童血细胞分析参考区间: WS/T 779-2021[S]. 北京: 中国标准出版社, 2021.
9 Stopyra L, Kowalik A, Stala J, et al. The age-related course of COVID-19 in pediatric patients-1405 cases in a single center[J]. J Clin Med, 2022, 11(24): 7347. PMID: 36555963. PMCID: PMC9782360. DOI: 10.3390/jcm11247347.
10 Ward JL, Harwood R, Smith C, et al. Risk factors for PICU admission and death among children and young people hospitalized with COVID-19 and PIMS-TS in England during the first pandemic year[J]. Nat Med, 2022, 28(1): 193-200. PMID: 34931076. DOI: 10.1038/s41591-021-01627-9.
11 Li W, Moore MJ, Vasilieva N, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus[J]. Nature, 2003, 426(6965): 450-454. PMID: 14647384. PMCID: PMC7095016. DOI: 10.1038/nature02145.
12 Bunyavanich S, Do A, Vicencio A. Nasal gene expression of angiotensin-converting enzyme 2 in children and adults[J]. JAMA, 2020, 323(23): 2427-2429. PMID: 32432657. PMCID: PMC7240631. DOI: 10.1001/jama.2020.8707.
13 Asadi-Pooya AA. Seizures associated with coronavirus infections[J]. Seizure, 2020, 79: 49-52. PMID: 32416567. PMCID: PMC7212943. DOI: 10.1016/j.seizure.2020.05.005.
14 Narula N, Joseph R, Katyal N, et al. Seizure and COVID-19: association and review of potential mechanism[J]. Neurol Psychiatry Brain Res, 2020, 38: 49-53. PMID: 33071468. PMCID: PMC7553058. DOI: 10.1016/j.npbr.2020.10.001.
15 Sener Okur D. Neurological symptoms and signs associated with COVID-19 in pediatric patients: a single-center experience[J]. Medicine (Baltimore), 2022, 101(31): e29920. PMID: 35945769. PMCID: PMC9351517. DOI: 10.1097/MD.0000000000029920.
16 Cadet K, Boegner J, Ceneviva GD, et al. Evaluation of febrile seizure diagnoses associated with COVID-19[J]. J Child Neurol, 2022, 37(5): 410-415. PMID: 35286175. PMCID: PMC9086105. DOI: 10.1177/08830738221086863.
17 Cloete J, Kruger A, Masha M, et al. Paediatric hospitalisations due to COVID-19 during the first SARS-CoV-2 Omicron (B.1.1.529) variant wave in South Africa: a multicentre observational study[J]. Lancet Child Adolesc Health, 2022, 6(5): 294-302. PMID: 35189083. PMCID: PMC8856663. DOI: 10.1016/S2352-4642(22)00027-X.
18 Bova SM, Serafini L, Serati I, et al. Seizures may be an early sign of acute COVID-19, and the Omicron variant could present a more epileptogenic profile[J]. Acta Paediatr, 2022, 111(9): 1814-1815. PMID: 35615863. PMCID: PMC9348245. DOI: 10.1111/apa.16424.
19 Zong X, Gu Y, Yu H, et al. Thrombocytopenia is associated with COVID-19 severity and outcome: an updated meta-analysis of 5637 patients with multiple outcomes[J]. Lab Med, 2021, 52(1): 10-15. PMID: 32929506. PMCID: PMC7543465. DOI: 10.1093/labmed/lmaa067.
20 Xia W, Shao J, Guo Y, et al. Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults[J]. Pediatr Pulmonol, 2020, 55(5): 1169-1174. PMID: 32134205. PMCID: PMC7168071. DOI: 10.1002/ppul.24718.
21 Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China[J]. Nature, 2020, 579(7798): 265-269. PMID: 32015508. PMCID: PMC7094943. DOI: 10.1038/s41586-020-2008-3.
22 Singh A, Bhadani PP, Surabhi, et al. Significance of immune-inflammatory markers in predicting clinical outcome of COVID-19 patients[J]. Indian J Pathol Microbiol, 2023, 66(1): 111-117. PMID: 36656221. DOI: 10.4103/ijpm.ijpm_658_21.
PDF(582 KB)
