摘要
目的系统评价孕产妇及儿童(<18岁)中东呼吸综合征(MERS)患者的临床资料,为冠状病毒感染疾病防治提供借鉴和参考。方法计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、CNKI、VIP和WanFang Data数据库,搜集关于孕产妇及儿童MERS患者的临床研究,检索时限均为建库至2020年2月15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。结果共纳入11个研究,包括MERS冠状病毒(MERS-CoV)感染孕产妇12例,儿童21例。研究结果显示:儿童患者的男女比例1∶1.63,年龄9月~16岁;主要感染途径为家庭接触感染,占57.1%(12/21);无症状患者占57.1%(12/21),最常见症状为发热、咳嗽、气促,部分患儿出现呕吐、腹泻等消化道症状;MERS-CoV核酸检测阳性率为100%(21/21),胸片显示73.7%(14/19)无明显病变,出现病变者以双侧改变为主;重症3例,均有较严重基础疾病,死亡率为9.5%(2/21)。孕产妇感染者年龄27~39岁,孕周6~38周;以医院内感染为主,占57.1%(4/7);最常见的临床表现为发热、咳嗽和气促,2例孕妇出现腹痛;MERS-CoV核酸检测阳性率为100.0%(11/11),影像学以双侧病变为主,占55.6%(5/9);重症占80.0%(8/10),死亡4例,重症患者死亡率达50.0%(4/8);确诊感染孕妇分娩活产儿10例,死产2例,新生儿中1例因过早产死亡,其余9例存活新生儿未感染MERS-CoV,无母婴垂直传播证据。结论儿童MERS病例临床症状大致与成人相似,但总体整体症状轻,伴有基础疾病者出现重症的比例高。孕产妇感染后重症患者及病死率较高,应加强妊娠期妇女的管理,警惕院内感染。目前尚未见MERS-CoV垂直传播的证据。
Objectives To systematically review the clinical characteristics of pregnant females and juveniles(<18 years) with Middle East Respiratory Syndrome(MERS), so as to provide evidence for epidemic prevention and treatment of COVID-19. Methods PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect studies on clinical characteristics of pregnant females and juveniles with MERS from inception to February 15 th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Descriptive analysis was then performed. Results A total of 12 studies involving12 pregnant females, and 21 juveniles with MERS were included. The results of studies showed that the male to female ratio of juveniles patients was 1 to 1.63 and the age ranged from 9 months to 16 years. The primary transmission route of juveniles cases was family contact infection, accounting for 57.1%(12/21). Asymptomatic juveniles accounted for57.1%(12/21), and the most common symptoms were fever, cough and shortness of breath. Some patients exhibited gastrointestinal symptoms such as vomiting and diarrhea. The positive rate of MERS-CoV RCT test was 100.0%(21/21).As for chest radiograph, 73.7%(14/19) cases showed no obvious lesions, and juveniles with lesions were mainly bilateral. 3 patients with underlying diseases developed severe cases, the mortality was 9.5%(2/21). The age range of pregnant women was 27 to 39, with the gestational age from 6 to 38 weeks. The primary transmission route for pregnant women was nosocomial infection, accounting for 57.1%(4/7). Fever, cough, shortness of breath were common manifestations, while abdominal pain occurred in two female patients. The positive rate of MERS-CoV RCT test was 100.0%(11/11). The chest radiograph findings were mainly bilateral lesions, accounting for 55.6%(5/9). 80.0% of whole pregnant females were severe cases(8/10), 4 of them died, with the 50.0%(4/8) mortality in severe pregnant cases. Among the infective pregnant women, 2 were stillborn and 10 were delivered, of which 1 died due to premature delivery. The remaining 9 surviving newborns were not infected with MERS-CoV and there was no evidence of mother-to-child transmission.Conclusions The clinical symptoms of MERS in juveniles are similar to those in adults, however, considerably milder.Severe case rate is higher in patients with underlying diseases. However, maternal infections could be much severe with higher mortality. It is particularly important to strengthen the management of pregnant females, especially prevent hospital infection. There is still no evidence of MERS-CoV mother-to-child transmission.
作者
何洋
唐军
张萌
曾燕
岳艳
李文星
胡鹏
熊涛
母得志
李幼平
HE Yang;TANG Jun;ZHANG Meng;ZENG Yan;YUE yan;LI Wenxing;HU Peng;XIONG Tao;MU Dezhi;LI Youping(Department of Pediatrics,West China Second Hospital,Sichuan University,Chengdu 610041,P.R.China;Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University),Ministry of Education,Chengdu 610041,P.R.China;Chinese Evidence-based Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)
出处
《中国循证医学杂志》
CSCD
北大核心
2020年第5期576-584,共9页
Chinese Journal of Evidence-based Medicine
