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

摘要:

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。

Abstract:

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.