切换至 "中华医学电子期刊资源库"

中华实验和临床感染病杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 86 -91. doi: 10.3877/cma.j.issn.1674-1358.2021.02.003

所属专题: 经典病例 文献

论著

184例百日咳婴幼儿临床特征
王彩英1, 张慧敏1, 张艳兰1, 刘玉环1, 杨洪玲1, 何树新1, 庞琳1,()   
  1. 1. 100015 北京,首都医科大学附属北京地坛医院儿科
  • 收稿日期:2020-05-20 出版日期:2021-04-15
  • 通信作者: 庞琳
  • 基金资助:
    首都医科大学附属北京地坛医院重点实验室开放研究课题(No. 2209-25-111); 首都医科大学附属北京地坛医院院内科研基金"育苗计划"项目(No. DTYM201817); 首都临床特色应用研究与成果推广项目(No. Z161100000616030)

Clinical characteristics of 184 infants with whooping cough

Caiying Wang1, Huimin Zhang1, Yanlan Zhang1, Yuhuan Liu1, Hongling Yang1, Shuxin He1, Lin Pang1,()   

  1. 1. Department of Pediatrics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2020-05-20 Published:2021-04-15
  • Corresponding author: Lin Pang
引用本文:

王彩英, 张慧敏, 张艳兰, 刘玉环, 杨洪玲, 何树新, 庞琳. 184例百日咳婴幼儿临床特征[J/OL]. 中华实验和临床感染病杂志(电子版), 2021, 15(02): 86-91.

Caiying Wang, Huimin Zhang, Yanlan Zhang, Yuhuan Liu, Hongling Yang, Shuxin He, Lin Pang. Clinical characteristics of 184 infants with whooping cough[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2021, 15(02): 86-91.

目的

分析住院治疗的百日咳婴幼儿的临床资料,探讨婴幼儿百日咳的临床特征。

方法

收集2017年12月至2018年12月于首都医科大学附属北京地坛医院儿科住院治疗的184例百日咳婴幼儿为研究对象,采集患儿的临床资料,包括年龄、性别、疫苗接种,痉挛性咳嗽、发绀、肺部体征以及血常规、C-反应蛋白(CRP)、降钙素原(PCT)、丙氨酸氨基转移酶(ALT)、肌酸激酶同工酶、痰细菌培养、胸部CT或X线平片进行回顾性分析。根据病情将入组患儿分为普通病例和重症病例,采用独立样本t检验、非参数检验或卡方检验分析两组患儿的上述指标。

结果

184例住院治疗的百日咳患儿中,< 6月龄患儿133例(72.28%),120例(65.22%)患儿未接种百日咳疫苗;分别有162例(88.04%)和91例(49.46%)患儿发生痉挛性咳嗽和咳嗽时发绀,154例(83.70%)患儿合并肺炎,119例(64.67%)患儿白细胞计数为(10~30)× 109/L,40例(21.74%)患儿白细胞> 30 × 109/L;分别有25例(13.59%)、31例(16.85%)和11例(5.98%)患儿中性粒细胞百分比、CRP和PCT水平升高;23例(12.5%)患儿痰标本其他细菌(除百日咳鲍特杆菌外)培养阳性;平均住院时间为(15.68 ± 8.11)d;分别有26例(14.13%)和19例(10.33%)患儿使用3种以上和特殊级别抗菌药物(碳青霉烯类和糖肽类)。22例重症患儿中18例(81.82%)发生呼吸功能衰竭,16例(72.73%)发生心功能衰竭,11例(50%)频繁发生呼吸暂停,3例(13.64%)发生百日咳脑病,4例(18.18%)死亡。与普通病例组患儿相比,重症病例组患儿年龄小[平均月龄:(2.80 ± 1.26) vs. (4.97 ± 4.30),t =-2.31、P = 0.02],< 3月龄(63.64% vs. 38.89%,χ2 = 4.88、P = 0.027)及未接种百日咳疫苗比例高(100% vs. 60.49%,χ2 = 13.33、P < 0.001);发生肺实变(77.27% vs. 1.85%,χ2 = 106.08、P < 0.001)、发热(86.36% vs. 20.99%,χ2 = 40.37、P < 0.001)、中性粒细胞百分比(68.18% vs. 6.17%,χ2 = 58.26、P < 0.001)、CRP(50.00% vs. 12.33%,χ2 = 17.01、P < 0.001)及PCT升高比例(40.91% vs. 1.23%,χ2 = 47.41、P < 0.001)、痰其他细菌培养阳性率(36.36% vs. 9.26%,χ2 = 10.65、P < 0.001)均显著增高;白细胞计数以及发生重度高白细胞血症(白细胞> 50 × 109/L)比例亦显著增高[30.99(27.48,43.12)× 109/L vs. 18.33(12.35,25.59)× 109/L,Z =-3.98,P < 0.001;18.18% vs. 0%,P < 0.001(Fisher确切概率法)],差异均有统计学意义。痰细菌培养阳性的重症患儿以院内感染阴性杆菌多见(鲍曼不动杆菌3例,铜绿假单胞菌2例,其他肺炎克雷伯杆菌、阴沟肠杆菌、产气肠杆菌等阴性杆菌5例)。死亡的4例患儿均发生肺实变,其中3例白细胞计数> 50 × 109/L,死亡原因为呼吸功能衰竭和感染性休克。

结论

住院治疗的百日咳婴幼儿中< 6月龄以及未接种百日咳疫苗的比例较高,肺炎为百日咳婴幼儿的主要并发症;重症百日咳婴幼儿年龄更小,并发重症肺炎、重度高白细胞血症为重症百日咳诊治的重点。

Objective

To analyze the clinical data of hospitalized infants with whooping cough, and to explore the clinical characteristics of infant with whooping cough.

Methods

Total of 184 infants diagnosed with whooping cough, who were hospitalized in Beijing Ditan Hospital, Capital Medical University from December 2017 to December 2018 were selected. Clinical data of the infants, including age, sex, vaccination status, symptoms of spasmodic cough and cyanosis, lung signs, routine blood test, C reactive protein (CRP), procalcitonin (PCT), alanine aminotransferase, creatine kinase isozyme, sputum bacterial culture results and chest computed tomography (CT) or X-rays were analyzed, retrospectively. The infants were divided into common cases group and severe cases group according to clinical manifestation, and the independent sample t-test, rank sum test or chi-square test were used to analyze the above indexes of the infants in both groups.

Results

Among the 184 cases, 133 cases (72.28%) were younger than 6 months, and 120 cases (65.22%) did not receive pertussis vaccine; 162 cases (88.04%) and 91 cases (49.46%) had paroxysmal cough and cyanosis, respectively, and 154 cases (83.70%) had pneumonia; white blood cells (WBC) were (10-30) × 109/L in 119 cases (64.67%) and WBC > 30 × 109/L in 40 cases (21.74%). There were 25 cases (13.59%), 31 cases (16.85%) and 11 cases (5.98%) had increased level of neutrophile granulocyte percentage, CRP and PCT, respectively; and 23 cases (12.5%) were positive for other bacteria in sputum culture (excluding Bordetella pertussis); the length of hospital stay was (15.68 ± 8.11) days; 26 cases (14.13%) and 19 cases (10.33%) had used more than 3 antibiotics and special grade antibiotics (glycopeptide and carbapenem antibiotics), respectively. There were 22 severe cases, and respiratory failure occurred in 18 cases (81.82%), heart failure occurred in 16 cases (72.73%), 11 (50%) cases had frequent apnea, 3 (13.64%) cases had pertussis encephalopathy, and 4 (18.18%) cases died. Compared with common cases, severe cases were younger [(2.80 ± 1.26) months vs. (4.97 ± 4.30) months; t =-2.31, P = 0.02)], and had higher percentage of cases younger than 3 months (63.64% vs. 38.89%; χ2 = 4.88, P = 0.027), and higher percentage of cases who did not receive pertussis vaccine (100% vs. 60.49%; χ2 = 13.33, P < 0.001). The cases with pulmonary consolidation (77.27% vs. 1.85%; χ2 = 106.08, P < 0.001), fever (86.36% vs. 20.99%; χ2 = 40.37, P < 0.001), increased percentage of neutrophile granulocytes (68.18% vs. 6.17%; χ2 = 58.26, P < 0.001), increased CRP (50.00% vs. 12.33%; χ2 = 17.01, P < 0.001) and PCT level (40.91% vs. 1.23%; χ2 = 47.41, P < 0.001), higher positive rate of other sputum culture (36.36% vs. 9.26%; χ2 = 10.65, P < 0.001) in severe cases group were significantly more than common cases group. Leucocyte count [30.99 (27.48, 43.12) × 109/L vs. 18.33 (12.35, 25.59) × 109/L; Z =-3.98, P < 0.001] and the rate of severe hyperleukemia (18.18% vs. 0%; P < 0.001) by Fisher exact probability method were also significantly higher in severe cases than those of common cases. Hospital-infected Gram-negative bacillus was common in severe cases (3 cases with Acinetobacter baumannii infection, 2 cases with Pseudomonas aeruginosa infection, and 5 cases with Klebsiella pneumoniae, Enterobacter cloacae or Enterobacter aerogenes infection). All the 4 deaths had pulmonary consolidation, the causes of whom were respiratory failure and infectious shock, and 3 of whom with WBC count ≥ 50 × 109/L.

Conclusions

The hospitalized whooping cough infants had a high percentage of younger than 6 months and a high rate without pertussis vaccination, and pneumonia was the most common complication. Severe cases were younger, and often complicated with severe pneumonia and severe hyperleukemia, which were the key points of treatment to severe pertussis.

表1 婴幼儿百日咳的一般资料和临床特征
  总病例数(184例) 重症病例(22例) 普通病例(162例) 统计量 P
性别[例(%)]       χ2 = 0.01 0.930a
  102(55.43) 12(54.55) 90(55.56)    
  82(44.57) 10(45.45) 72(44.44)    
年龄       Z =-2.92 0.004d
  < 3月龄[例(%)] 77(41.85) 14(63.64) 63(38.89) χ2 = 4.88 0.027a
  3~6月[例(%)] 56(30.43) 8(36.36) 48(76.19) χ2 = 0.42 0.520a
  6月~1岁[例(%)] 36(19.57) 0(0.00) 36(22.22) χ2 = 4.75 0.009b
  > 1岁[例(%)] 15(8.15) 0(0.00) 15(9.26) χ2 = 1.15 0.029b
未接种百日咳疫苗[例(%)] 120(65.22) 22(100.00) 98(60.49) χ2 = 13.33 < 0.001a
痉挛性咳嗽[例(%)] 162(88.04) 22(100.00) 140(86.42) χ2 = 2.23 0.136b
咳嗽时发绀[例(%)] 91(49.46) 22(100.00) 69(42.59) χ2 = 22.54 < 0.001a
发热[例(%)] 53(28.80) 19(86.36) 34(20.99) χ2 = 40.37 < 0.001a
肺部啰音[例(%)] 66(35.87) 21(95.45) 45(27.78) χ2 = 38.57 < 0.001a
肺炎[例(%)] 154(83.70) 22(100.00) 132(81.48) χ2 = 3.61 0.058b
肺实变[例(%)] 20(10.87) 17(77.27) 3(1.85) χ2 = 106.08 < 0.001b
心肌酶增高[例(%)] 58(31.52) 16(72.73) 42(25.93) χ2 = 19.66 < 0.001a
ALT增高[例(%)] 42(22.83) 10(45.45) 32(19.75) χ2 = 7.26 0.007a
白细胞       Z =-4.67 < 0.001d
  < 10 × 109/L [例(%)] 25(13.59) 1(4.55) 24(14.81) χ2 = 0.98 0.323b
  (10~30)×109/L [例(%)] 119(64.67) 7(31.82) 112(69.14) χ2 = 11.81 0.001a
  (30~50)× 109/L [例(%)] 36(19.57) 10(45.45) 26(16.05) χ2 = 8.86 0.003b
  > 50 × 109/L [例(%)] 4(2.17) 4(18.18) 0(0.00) < 0.001c
中性粒细胞增高[例(%)] 25(13.59) 15(68.18) 10(6.17) χ2 = 58.26 < 0.001b
血小板增多(> 300 × 1012/L)[例(%)] 184(100.00) 22(100.00) 162(100.00) / /
血小板(× 1012/L) 501.55(427.68,616.58) 619.55(486.60,690.78) 489.50(424.83,552.33) Z =-2.55 0.010
CRP增高[例(%)] 31(16.85) 11(50.00) 20(12.33) χ2 = 17.01 < 0.001b
PCT增高[例(%)] 11(5.98) 9(40.91)) 2(1.23) χ2 = 47.41 < 0.001b
痰其他细菌培养阳性(除外百日咳鲍特杆菌) [例(%)] 23(12.50) 8(36.36) 15(9.26) χ2 = 10.65 0.001b
住院时间[M(P25,P75),d] 13.00(11.00,18.00) 24.00(19.00,29.00) 12.00(10.25,16.00) Z =-4.46 < 0.001
3种及以上抗菌药物[例(%)] 26(14.13) 18(81.82) 8(4.94) χ2 = 88.12 < 0.001b
特殊级抗菌药物[例(%)] 19(10.33) 15(68.18) 4(2.47) χ2 = 83.37 < 0.001b
呼吸机辅助呼吸[例(%)] 14(7.61) 14(63.64) 0(0.00) χ2 = 102.71 < 0.001b
死亡病例[例(%)] 4(2.17) 4(18.18) 0(0.00) < 0.001c
表2 23例痰细菌培养阳性百日咳并发肺炎患儿的病原学分布
[1]
Mbayei SA, Faulkner A, Miner C, et al. Severe pertussis infections in the United States, 2011-2015[J]. Clin Infect Dis,2019,69(2):218-226.
[2]
Matthias J, Pritchard PS, Martin SW, et al. Sustained transmission of pertussis in vaccinated, 1-5-year-old children in a preschool, Florida, USA[J]. Emerg Infect Dis,2016,22(2):242-246.
[3]
Straney L, Schibler A, Ganeshalingham A, et al. Burden and outcomes of severe pertussis infection in critically ill infants[J]. Pediatr Crit Care Med,2016,17(8):735-742.
[4]
邓继岿, 王红梅, 田树凤. 中国儿童百日咳诊断及治疗建议[J]. 中华儿科杂志,2017,55(8):568-571.
[5]
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.
[6]
Machado MB, Passos SD. Severe pertussis in childhood: update and controversy-systematic review[J]. Rev Paul Pediatr,2019,37(3):351- 362.
[7]
Amirthalingam G, Andrews N, Campbell H, et al. Effectiveness of maternal pertussis vaccination in England: an observational study[J]. Lancet,2014,384(9953):1521-1528.
[8]
Dabrera G, Amirthalingam G, Anderews N, et al. A case-control study to estimate the effectiveness of maternal pertussis vaccination in protecting newborn infants in England and Wales, 2012-2013[J]. Clin Infect Dis,2015,60(3):333-337.
[9]
Winter K, Cherry JD, Harriman K. Effectiveness of prenatal tetanus, diphtheria, and acellular pertussis vaccination on pertussis severity in infants[J]. Clinl Infect Dis,2017,64(1):1-6.
[10]
Sadiasa A, Saito-Obata M, Dapat C, et al. Bordetella pertussis infection in children with severe pneumonia, Philippines, 2012-2015[J]. Vaccine,2017,35(7):993-996.
[11]
周凯, 韩青. 百日咳致婴儿死亡的机制和预防[J]. 中华实用儿科临床杂志,2017,32(22):1699-1701.
[12]
Kazantzi MS, Prezerakou A, Kalamitsou SN, et al. Characteristics of Bordetella pertussis infection among infants. and children admitted to paediatric intensive care units in Greece: a multicentre, 11-year study[J]. J Paediatr Child Health,2017,53(3):257-262.
[13]
魏雪梅, 杨慧, 雷旻, 等. 换血治疗婴儿重症百日咳合并高白细胞血症1例报道[J]. 中国当代儿科杂志,2019,21(3):214-217.
[14]
James DC. The prevention of severe pertussis and pertussis deaths in young infants[J]. Expert Rev Vaccines,2019,18(3):205-208.
[15]
Berger JT, Carcillo JA, Shanley TP, et al. Critical pertussis illness in children: a multicenter prospective cohort study[J]. Pediatr Crit Care Med,2013,14(4):356-365.
[16]
Ganeshalingham A, McSharry B, Anderson B, et al. Identifying children at risk of malignant bordetella pertussis infection[J]. Pediatr Crit Care Med,2017,18(1):e42-e47.
[17]
Grzeszczak MJ, Churchwell KB, Edwards KM, et al. Leukopheresis therapy for severe infantile pertussis with myocardial and pulmonary failure[J]. Pediatr Crit Care Med,2006,7(6):580-582.
[18]
Rowlands HE, Goldman AP, Harrington K, et al. Impact of rapid leukodepletion on the outcome of severe clinical pertussis in young infants[J]. Pediatrics,2010,126(4):e816-e827.
[19]
Tian SF, Wang HM, Deng JK. Fatal malignant pertussis with hyperleukocytosis in a Chinese infant[J]. Medicine,2018,97(17): e0549.
[20]
项龙, 曹清, 奚悦玲, 等. 白细胞去除术治疗婴儿高白细胞合并肺动脉高压百日咳三例并文献复习[J]. 中国小儿急救医学,2018,25(11): 801-806.
[21]
Cherry JD, Wendorf KA, Bregman B, et al. An observational study or severe pertussis in 100 infants ≤ 120 days of age[J]. Pediatr Infect Dis,2018,37(3):202-205.
[22]
Tiwari TS, Baughman AL, Clark TA. First pertussis vaccine dose and prevention of infant mortality[J]. Pediatrics,2015,135(6):990-999.
[23]
Curtis C, Baughman A, DeBolt C, et al. Risk factors associated with Bordetella pertussis among infants ≤ 4 months of age in the pre-Tdap Era: United States, 2002-2005[J]. Pediatr Infect Dis J,2017,36(8):726-735.
[24]
Cherry JD. Pertussis in young infants throughout the world[J]. Clin Infect Dis,2016,63(S4):S119-S122.
[25]
Fedele G, Carollo M, Palazzo R, et al. Parents as a source of pertussis transmission in hospitalized young infants[J]. Infection, 2017,45(2):171-178.
[1] 张烈, 严一核, 杜洁瑜. 分泌型白细胞蛋白酶抑制因子对无创呼吸机治疗重症肺炎患者的预测效能[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 301-306.
[2] 高娟, 郑枫, 张晴, 朱琳娜, 王娴. 三种常用临床指标在重症肺炎患者液体管理监测中的比较研究[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(03): 204-210.
[3] 顾盼盼, 董传莉, 宋梦瑶, 瞿色华, 杨小迪, 周瑞. 不完全性川崎病患儿临床特征及冠状动脉损害情况分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 446-451.
[4] 丁科, 张亚琼, 刘杰, 邓莉平, 张永喜, 熊勇. 获得性免疫缺陷综合征相关淋巴瘤患者的临床特征及生存状况的变化趋势[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 278-284.
[5] 徐保平, 彭怀文, 喻怀斌, 王晓涛. 新型冠状病毒肺炎继发糖尿病酮症酸中毒合并肝门静脉积气一例[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(04): 250-255.
[6] 张超, 张珍, 马梁, 穆欢欢, 刘彩玲. 腹腔镜胰十二指肠切除术术后C级胰瘘患者临床特征及影响因素研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 675-678.
[7] 高佳, 姜吉询, 王鑫, 吴婷, 向江明. 病理性乳头溢液单中心临床分析附168例报告[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(03): 323-326.
[8] 颜晓敏, 崔嵘嵘. 23例乳腺佩吉特病的经验交流[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(03): 353-354.
[9] 杨柳, 陈佳, 孙雅娟, 陈娇, 谭明超, 龚明福. 抗中性粒细胞胞浆抗体相关性血管炎的胸部CT 及临床特征分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 744-749.
[10] 于燕兴, 梅喜庆, 刘凤娟, 于梓薇, 许亚慧, 徐飞. 高通量测序重症肺炎肺泡灌洗液病原体的临床应用[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 785-788.
[11] 刘雯, 赵明栋, 夏伟, 潘以雄. 不同剂量比阿培南治疗重症肺炎的疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 789-792.
[12] 杨攀, 黄晓寒, 邓才霞, 周利航, 周向东, 罗虎. SMARCA4缺失的胸部未分化肿瘤临床特征及预后分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 529-534.
[13] 李广林, 唐凯, 卢秀珍. 部分调节性内斜视的临床研究进展[J/OL]. 中华眼科医学杂志(电子版), 2024, 14(03): 177-181.
[14] 刘郁, 段绍斌, 丁志翔, 史志涛. miR-34a-5p 在结肠癌患者的表达及其与临床特征及预后的相关性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 485-490.
[15] 刘昌恩, 李岩, 张其德. 基于内镜筛查发现的自身免疫性胃炎的临床特征分析[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(04): 233-237.
阅读次数
全文


摘要