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百日咳患儿临床特点及危险因素分析
Clinical features and risk factors of pertussis in children
目的 探讨百日咳患儿的临床特点及感染的危险因素。方法 回顾性对比分析253例百日咳住院患儿（百日咳组）与同期314例咳嗽住院患儿（对照组）的临床资料及免疫功能相关实验室指标结果。百日咳鲍特菌DNA检测采用实时荧光PCR法。收集两组患儿疫苗免疫、可疑患者接触史及住址分布的信息行百日咳危险因素分析。结果 对两组患儿进行23项典型临床指标比较，结果百日咳组患儿仅10项典型临床指标不同于对照组（P < 0.05）。两组患儿并发症中，仅百日咳组心肌炎发生率低于对照组（P < 0.05）。百日咳组患儿血清球蛋白、IgM水平显著低于对照组（P < 0.05）。百日咳组患儿百白破联合疫苗未免疫、未及时免疫及可疑患者接触史比率显著高于对照组（P < 0.05）；疫苗未免疫、未及时免疫、可疑患者接触史是百日咳感染的危险因素（P < 0.05）。结论 百日咳患儿常不具备典型的临床特征，实时荧光PCR法检测百日咳鲍特菌DNA有助于不典型百日咳患儿的早期诊断。婴幼儿应及时进行百日咳疫苗免疫接种，并与可疑患者做好隔离防护，降低百日咳发生率。
Objective To study the clinical features and risk factors of pertussis in children.Methods A retrospective analysis was performed for the clinical data and laboratory markers for immune function of 253 hospitalized children with pertussis. A total of 314 hospitalized children with cough were used as the control group. Quantitative real-time PCR was used to detect Bordetella pertussis DNA. The clinical data of both groups were collected to analyze the risk factors for pertussis.Results A total of 23 typical clinical parameters were compared between the pertussis and control groups, and there were significant differences in only 10 clinical parameters between the two groups (P < 0.01). As for the complications observed in the two groups, the pertussis group had a significantly lower incidence rate of myocarditis than the control group (P < 0.05). The pertussis group had significantly lower levels of serum globulin and IgM than the control group (P < 0.05). Compared with the control group, the pertussis group had a significantly higher proportion of children with a lack of diphtheria-pertussis-tetanus immunization or timely immunization and a contact history of suspected pertussis patients (P < 0.05). A lack of vaccine immunization or timely immunization and a contact history of suspected pertussis patients were risk factors for pertussis (P < 0.05).Conclusions The clinical features are not typical in children with pertussis. Quantitative real-time PCR for detecting Bordetella pertussis DNA helps with the early diagnosis of atypical pertussis. Infants/toddlers should be immunized in time and be isolated from suspected pertussis patients to reduce the incidence of pertussis.
[1] World Health Organization. WHO-recommended surveillance standard of pertussis[EB/OL]. (2017-08). http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/passive/pertussis_standards/en/.
[2] World Health Organization. Laboratory manual for the diagnosis of whooping cough caused by bordetella pertussis/Bordetella parapertussis[EB/OL]. (2014-03). http://apps.who.int/iris/bitstream/10665/127891/1/WHO-IVB-14.03-eng.pdf?.
[3] 中华医学会儿科学分会感染学组, 《中华儿科杂志》编辑委员会. 中国儿童百日咳诊断及治疗建议[J].中华儿科杂志, 2017, 55(8):568-572.
[4] Hozbor D, Mooi F, Flores D, et al. Pertussis epidemiology in Argentina:trends over 2004-2007[J]. 2009, 59(4):225-231.
[5] 窦聪, 刘奉琴, 郭春艳, 等. 2012年至2014年百日咳流行特征及住院患者临床特点分析[J]. 中华实用儿科临床杂志, 2016, 31(20):1559-1562.
[6] 胡云鸽, 刘泉波. 儿童百日咳247例临床特点及重症百日咳危险因素分析[J]. 中华儿科杂志, 2015, 53(9):684-689.
[7] Wang K, Bettiol S, Thompson MJ, et al. Symptomatic treatment of the cough in whooping cough[J]. Cochrane Database Syst Rev, 2014, (9):CD003257.
[8] 姚开虎, 邓继岿, 热夏提·达吾提. 百日咳诊断:现行标准的局限性和GPI建议[J]. 中国当代儿科杂志, 2016, 18(9):891-896.
[9] 张文宏. 全球百日咳现状以及免疫策略进展[J]. 中国疫苗和免疫, 2009, 15(5):467-472.
[10] Hewlett EL, Bums DL, Cotter PA, et al. Pertussis pathogenesis -what we know and what we don't know[J]. J Infect Dis, 2014, 209(7):982-985.
[11] 米荣, 伏瑾, 王晓颖, 等. 迁延性咳嗽婴幼儿百日咳感染临床情况调查[J]. 中华医学杂志, 2013, 93(22):1721-1725.
[12] 安志杰, 张颖左, 树岩. 榆林市百日咳流行病学分析及危险因素研究[J]. 中国计划免疫, 2007, 13(3):252-256.
[13] Bisgard KM, Rhodes P, Connelly BL, et al. Pertussis vaccine effectiveness among children 6 to 59 month sofage in the United States, 1998-2001[J]. Pediatrics, 2005, 116(2):e285-e294.
[14] World Health Organization. Immunological basis for immunization:pertussis (2017 update)[EB/OL]. (2017-11). http://www.who.int/immunization/documents/WHO_IVB_ISBN9789241513173/en/.
[15] 姚开虎, 贾举. 加强百日咳研究和防控, 维护公众疫苗接种信心-关注效价指标不合格疫苗事件及其长期影响[J]. 中国当代儿科杂志, 2018, 20(1):1-4.
[16] 黄辉, 邓莉, 肖飞. 儿童百日咳发病特点及诊断中联合呼吸道病毒检测的临床意义分析[J]. 中华儿科杂志, 2017, 55(8):580-585.
[17] 高志刚, 黄海涛, 刘勇, 等. 天津市百日咳反弹及流行病学特征改变的影响因素分析[J]. 中国疫苗和免疫, 2011, 17(3):212-215.
[18] Urwyler P, Heininger U. Protecting newborns from pertussis -the challenge of complete cocooning[J]. BMC Infect Dis, 2014, 14:397.
[19] 薛辛东, 杜立中. 儿科学[M]. 北京:人民卫生出版社, 2005:176-179.
[20] 尚红, 王毓三, 申子瑜. 全国临床检验操作规程[M]. 北京:人民卫生出版社, 2017:415-418.
山东泰安市科技发展计划立项项目（017NS0161）。
