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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 110 -116. doi: 10.3877/cma.j.issn.1674-1358.2023.02.006

论著

接种与未接种麻疹疫苗儿童麻疹的临床特征
苗敏, 杨洪玲, 刘洋, 庞琳†()   
  1. 100015　北京，首都医科大学附属北京地坛医院儿科
  • 收稿日期:2022-10-19 出版日期:2023-04-15
  • 通信作者: 庞琳
  • 基金资助:
    北京市医院管理局"扬帆"重点医学发展计划(No. ZYLX201602)

Clinical characteristics of measles in unvaccinated and vaccinated children

Min Miao, Honglin Yang, Yang Liu, Lin Pang†()   

  1. Department of Pediatrics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2022-10-19 Published:2023-04-15
  • Corresponding author: Lin Pang
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引用本文：

苗敏, 杨洪玲, 刘洋, 庞琳. 接种与未接种麻疹疫苗儿童麻疹的临床特征[J/OL]. 中华实验和临床感染病杂志(电子版), 2023, 17(02): 110-116.

Min Miao, Honglin Yang, Yang Liu, Lin Pang. Clinical characteristics of measles in unvaccinated and vaccinated children[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2023, 17(02): 110-116.

目的

探讨儿童接种麻疹疫苗与否对麻疹临床特征的影响。

方法

回顾性分析2009年3月至2019年7月首都医科大学附属北京地坛医院儿科收治的726例麻疹病例的临床资料：发病时间、性别、年龄、麻疹疫苗接种、临床表现、并发症、辅助检查及转归。根据是否接种麻疹疫苗将入组儿童分为未接种疫苗组（622例）和接种疫苗组（104例），采用Pearson卡方检验或连续校正卡方检验、秩和（Mann-Whitney U）检验比较两组患儿麻疹临床特征。

结果

726例患儿中男486例（66.9%）、女240例（33.1%），年龄[中位数（四分位数）]为8.6（6.6，11.9）个月，< 1岁患儿最多（占73.1%）。未接种疫苗组622例（85.7%），< 8个月患儿251例（40.4%）；接种疫苗组104例（14.3%），无< 8个月者。两组均以春季（3~5月份）为发病高峰。与接种疫苗组相比，未接种疫苗组患儿典型皮疹（67.0% vs. 50.0%：χ2 = 11.316、P = 0.001）、麻疹黏膜斑（Koplik斑）（61.7% vs. 38.5%：χ2 = 19.868、P < 0.001）、眼睑浮肿（22.5% vs. 11.5%：χ2 = 6.477、P = 0.011）、结膜充血（45.0% vs. 24.0%：χ2 = 16.095、P < 0.001）、眼分泌物（50.0% vs. 30.8%：χ2 = 13.221、P < 0.001）、流泪（12.1% vs. 3.8%：χ2 = 6.196、P = 0.013）、腹泻（29.3% vs. 18.3%：χ2 = 5.376、P = 0.020）、咳嗽（77.2% vs. 63.5%：χ2 = 8.980、P = 0.003）及呼吸道并发症喉炎（44.7% vs. 26.9%：χ2 = 11.541、P = 0.001）、肺炎（80.4% vs. 59.6%：χ2 = 21.982、P < 0.001）发生率均显著升高；而肝功异常发生率较低（12.1% vs. 34.6%：χ2 = 35.006、P < 0.001），差异均有统计学意义。

结论

接种麻疹疫苗对儿童麻疹临床特征存在影响，未接种麻疹疫苗儿童感染后临床表现典型，呼吸道并发症较多；接种过麻疹疫苗的麻疹儿童患者临床表现不典型。未接种麻疹疫苗儿童是麻疹的主要感染人群，故需关注适龄婴幼儿麻疹疫苗接种及补充免疫接种。

关键词: 儿童, 麻疹, 麻疹疫苗, 回顾性研究
Objective

To investigate the effect of measles vaccination on the clinical characteristics of measles in children.

Methods

Clinical data of 726 children with measles admitted to the Department of Pediatrics, BeijingDitan Hospital, Capital Medical University from March 2009 to July 2019 were analyzed, retrospectively, including onset time, gender, age, measles vaccination, clinical manifestations, complications, auxiliary examinations and prognosis. All children were grouped according to whether or not vaccinated against measles: the unvaccinated group (622 cases) and vaccinated group (104 cases), Chi-square test or continuously corrected Chi-square and rank sum (Mann-Whitney U) test were used to compare the clinical characteristics of measles between the two groups.

Results

Total of 726 children with measles were collected, including 486 boys (66.9%) and 240 girls (33.1%), the median age was [8.6 (6.6, 11.9)] months, among whom, children younger than one year old accounted for 73.1%. Total of 622 children (85.7%) were not vaccinated against measles, with 251 (40.4%) children aged 0-8 months, and 104 children (14.3%) were vaccinated, without < 8 months. The incidence peak was in spring (March to May) in both groups. For the cases in the vaccinated group, the incidence of typical rash (67.0% vs.50.0%: χ2 = 11.316, P = 0.001), measles mucosal plaque (Koplik plaque) (61.7% vs. 38.5%: χ2 = 19.868, P < 0.001), eyelid edema (22.5% vs. 11.5%: χ2 = 6.477, P = 0.011), conjunctival congestion (45.0% vs. 24.0%: χ2 = 16.095, P < 0.001), eye secretions (50.0% vs. 30.8%: χ2 = 13.221, P < 0.001), watery eyes (12.1% vs. 3.8%: χ2 = 6.196, P = 0.013), diarrhea (29.3% vs. 18.3%: χ2 = 5.376, P = 0.020), cough (77.2% vs. 63.5%: χ2 = 8.980, P = 0.003) and respiratory complications laryngitis (44.7% vs. 26.9%: χ2 = 11.541, P = 0.001) and pneumonia (80.4% vs. 59.6%: χ2 = 21.982, P < 0.001) in the unvaccinated group were significantly higher; while the incidence of liver damage (12.1% vs. 34.6%: χ2 = 35.006, P < 0.001) was significantly lower.

Conclusions

Measles vaccination has an effect on the clinical characteristics of children with measles. Children who are not vaccinated against measles have typical clinical manifestations and more respiratory complications. The clinical manifestations of children vaccinated against measles are atypical. Children who are not vaccinated against measles are the main cases infected with measles. Attention should be paid to measles vaccination and supplementary immunization for infants and young children.

Key words: Children, Measles, Measles vaccine, Retrospective research
图1 未接种疫苗组与接种疫苗组麻疹患儿年龄分布
图2 未接种疫苗组与接种疫苗组麻疹病例年份分布
图3 未接种疫苗组与接种疫苗组麻疹病例月份分布
表1 未接种疫苗组与接种疫苗组麻疹患儿临床特征[例（%）]
临床特征 未接种疫苗组（622例） 接种疫苗组（104例） χ2值 P值
高热 416（66.9） 78（75.0） 2.701a 0.100
典型皮疹 528（67.0） 70（50.0） 11.316a 0.001
Koplik斑 384（61.7） 40（38.5） 19.868a < 0.001
眼睑浮肿 140（22.5） 12（11.5） 6.477a 0.011
结膜充血 280（45.0） 25（24.0） 16.095a < 0.001
眼分泌物 311（50.0） 32（30.8） 13.221a < 0.001
畏光 32（5.1） 5（4.8） 0.021a 0.885
流泪 75（12.1） 4（3.8） 6.196a 0.013
流涕 174（28.0） 23（22.1） 1.547a 0.214
咳嗽 480（77.2） 66（63.5） 8.980a 0.003
腹泻 182（29.3） 19（18.3） 5.376a 0.020
喉炎 278（44.7） 28（26.9） 11.541a 0.001
支气管炎 95（15.3） 13（12.5） 0.541a 0.462
肺炎 500（80.4） 62（59.6） 21.982a < 0.001
呼吸衰竭 51（8.2） 5（4.8） 1.440a 0.230
ARDS 8（1.3） 1（1.0） 0.000b 1.000
肺气漏 15（2.4） 1（1.0） 0.327b 0.568
鹅口疮 84（13.5） 17（16.3） 0.601a 0.438
肝功能损害 75（12.1） 36（34.6） 35.006a < 0.001
心力衰竭 52（8.4） 7（6.7） 0.317a 0.574
脑炎 6（0.3） 1（1.9） 0.000b 1.000
重型麻疹 111（17.8） 16（15.4） 0.374a 0.541
临床治愈 606（97.4） 102（98.1） 0.003b 0.957
表2 未接种疫苗组与接种疫苗组麻疹患儿实验室指标[M（P25，P75）]
实验室指标 未接种疫苗组（622例） 接种疫苗组（104例） Z值 P值
WBC（× 109/L） 7.1（5.2，10.54） 8.77（6.08，12.18） －3.006 0.003
NE（%） 45.27（33.14，58.34） 44.55（25.77，63.13） －0.759 0.448
LYH（%） 45.44（33.40，57.40） 44.70（27.23，67.87） －0.634 0.526
CRP（mg/L） 3.0（0，14） 9.4（2.09，40.72） －4.225 < 0.001
ALT（U/L） 25.75（19.1，36.5） 26.7（17.47，80.17） －1.791 0.073
AST（U/L） 53.6（42.9，68.57） 49.65（38.35，92.65） －0.030 0.976
LDH（U/L） 540.35（442.82，650.47） 477.4（404.62，603.20） －3.191 0.001
CK-MB（U/L） 35（26，45） 30（23.00，42.25） －2.541 0.011
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