中国当代儿科杂志
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CN 43-1301/R
 
中国当代儿科杂志  2020, Vol. 22 Issue (8): 844-853    DOI:10.7499/j.issn.1008-8830.2005172
论著·临床研究 最新目录| 下期目录| 过刊浏览| 高级检索 |
儿童COVID-19的临床特征:一项关于SARS、MERS及COVID-19的系统评价
何洋1,2, 唐军1,2, 张萌1,2, 王浩然3, 李文星1,2, 熊涛1,2, 李幼平4, 母得志1,2
1. 四川大学华西第二医院儿科, 四川 成都 610041;
2. 出生缺陷与相关妇儿疾病教育部重点实验室, 四川 成都 610041;
3. 四川大学华西临床医学院, 四川 成都 610041;
4. 四川大学华西医院中国循证医学中心, 四川 成都 610041
Clinical features of coronavirus disease 2019 in children: a systemic review of severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019
HE Yang1,2, TANG Jun1,2, ZHANG Meng1,2, WANG Hao-Ran3, LI Wen-Xing1,2, XIONG Tao1,2, LI You-Ping4, MU De-Zhi1,2
Department of Pediatrics, West China Second Hospital, Sichuan University, Chengdu 610041, China
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摘要 

目的 系统总结新型冠状病毒肺炎(COVID-19)儿童病例的临床特征。方法 计算机检索PubMed、Embase、Web of Science、The Cochrane Library、中国知网、重庆维普和万方数据库,搜集关于儿童COVID-19的临床研究,检索时限均为建库至2020年5月21日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,对纳入研究进行描述性分析。并与严重呼吸窘迫综合征(SARS)、中东呼吸综合征(MERS)儿童病例相关指标进行比较。结果 共纳入75个研究,包括COVID-19儿童病例806例。研究结果显示:患儿年龄在生后36?h到18岁不等,男女比例为1.21?:?1。与SARS、MERS病例类似,COVID-19病例最常见感染方式为家庭聚集感染,占74.6%(601/806)。COVID-19、SARS及MERS病例临床症状相似,以发热、咳嗽为主。部分患儿出现消化道症状。上述三者无症状感染儿童比例分别为17.9%(144/806)、2.5%(2/81)及57.1%(12/21)。COVID-19、MERS病例胸部影像学病变以双侧为主,病变阳性率分别为63.4%(421/664)及26.3%(5/19),均低于其病毒核酸检测阳性率(分别为99.8%及100%)。而SARS病例胸部影像学以单侧病变为主,其影像学阳性率为88.9%(72/81),高于病毒核酸检测阳性率(29.2%)。COVID-19及SARS患儿粪便中均检测到病毒核酸,检测阳性率分别为60.2%(56/93)、71.4%(5/7)。COVID-19患儿重症率及病死率分别为4.5%(31/686)、0.1%(1/806);SARS儿童重症率及病死率分别为1.5%(1/68)、0%;MERS儿童重症率及病死率分别为14.3%(3/21)、9.5%(2/21)。结论 儿童COVID-19临床症状与儿童SARS、MERS相似,以发热、咳嗽为主,均存在无症状感染者,但COVID-19和SARS儿童的病情较MERS轻。家庭聚集感染为COVID-19儿童重要的感染方式。流行病学接触史、影像学检查及病毒核酸检测结果是诊断COVID-19的重要依据。

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何洋
唐军
张萌
王浩然
李文星
熊涛
李幼平
母得志
关键词 新型冠状病毒肺炎严重呼吸窘迫综合征中东呼吸综合征系统评价临床特点儿童    
Abstract:Objective To systematically summarize the clinical features of coronavirus disease 2019 (COVID-19) in children. Methods PubMed, Embase, Web of Science, The Cochrane Library, CNKI, Weipu Database, and Wanfang Database were searched for clinical studies on COVID-19 in children published up to May 21, 2020. Two reviewers independently screened the articles, extracted data, and assessed the risk of bias of the studies included. A descriptive analysis was then performed for the studies. Related indices between children with COVID-19 and severe acute respiratory syndromes (SARS) or Middle East respiratory syndrome (MERS) were compared. Results A total of 75 studies were included, with a total of 806 children with COVID-19. The research results showed that the age of the children ranged from 36 hours after birth to 18 years, with a male-female ratio of 1.21?:?1. Similar to SARS and MERS, COVID-19 often occurred with familial aggregation, and such cases accounted for 74.6% (601/806). The children with COVID-19, SARS, and MERS had similar clinical symptoms, mainly fever and cough. Some children had gastrointestinal symptoms. The children with asymptomatic infection accounted for 17.9% (144/806) of COVID-19 cases, 2.5% (2/81) of SARS cases, and 57.1% (12/21) of MERS cases. The children with COVID-19 and MERS mainly had bilateral lesions on chest imaging examination, with a positive rate of lesions of 63.4% (421/664) and 26.3% (5/19) respectively, which were lower than the corresponding positive rates of viral nucleic acid detection, which were 99.8% and 100% respectively. The chest radiological examination of the children with SARS mainly showed unilateral lesion, with a positive rate of imaging of 88.9% (72/81), which was higher than the corresponding positive rate of viral nucleic acid detection (29.2%). Viral nucleic acid was detected in the feces of children with COVID-19 or SARS, with positive rates of 60.2% (56/93) and 71.4% (5/7) respectively. The children with COVID-19 had a rate of severe disease of 4.6% (31/686) and a mortality rate of 0.1% (1/806), the children with SARS had a rate of severe disease of 1.5% (1/68) and a mortality rate of 0%, and those with MERS had a rate of severe disease of 14.3% (3/21) and a mortality rate of 9.5% (2/21). Conclusions Children with COVID-19 have similar symptoms to those with SARS or MERS, mainly fever and cough. Asymptomatic infection is observed in all three diseases. Children with COVID-19 or SARS have milder disease conditions than those with MERS. COVID-19 in children often occurs with familial aggregation. Epidemiological contact history, imaging examination findings, and viral nucleic acid testing results are important bases for the diagnosis of COVID-19.
Key wordsCoronavirus disease 2019    Severe acute respiratory syndrome    Middle East respiratory syndrome    Systematic review    Clinical feature    Child   
收稿日期: 2020-05-23     
基金资助:国家临床重点专科(儿科新生儿专业)建设项目(1311200003303)。
通讯作者: 唐军,女,教授。Email:tj1234753@sina.com。     E-mail: tj1234753@sina.com
作者简介: 何洋,女,博士研究生。
引用本文:   
何洋,唐军,张萌等. 儿童COVID-19的临床特征:一项关于SARS、MERS及COVID-19的系统评价[J]. 中国当代儿科杂志, 2020, 22(8): 844-853.
HE Yang,TANG Jun,ZHANG Meng et al. Clinical features of coronavirus disease 2019 in children: a systemic review of severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019[J]. CJCP, 2020, 22(8): 844-853.
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