摘要
背景我国多项研究显示,新型冠状病毒的流行使呼吸道合胞病毒(RSV)传播的流行模式发生了改变。目的探讨2023年广州地区儿童感染RSV的流行病学特征和临床特征,为优化诊疗、制定科学的RSV感染防控策略提供依据。设计横断面研究。方法纳入2023年1月1日至12月30日广州医科大学附属妇女儿童医疗中心收治的符合急性下呼吸道感染临床表现、入院后48 h内RSV咽拭子检测阳性,且需住院治疗的年龄≤16岁患儿,分为轻症组和重症组(包括重症毛细支气管炎及重症肺炎),对单纯RSV感染进行年龄分层,分析其流行病学特征和临床特征。主要结局指标RSV感染的严重程度。结果1091例RSV感染患儿中,男674例(61.8%),女417例;轻症组986例(90.4%),重症组105例;单纯RSV感染965例(88.4%),混合感染126例;有基础疾病229例(21.0%)。(1)月份分布:1—3月份无RSV感染住院病例,4月份190例(17.4%),5月份394例(36.1%),6月份197例(18.1%),之后逐渐下降,12月份7例(0.6%)。(2)年龄分布:965例单纯RSV感染患儿中,1月龄~6月龄318例(33%),>6月龄~12月龄177例(18.3%),>12月龄~2岁195例(20.2%),>2岁~4岁221例(22.9%),>4岁~6岁38例(3.9%),>6岁16例(1.7%)。(3)临床表现:发热、咳嗽、鼻塞、流涕、喘息是最常见的临床表现,呕吐和腹泻等消化道症状也不少见,喘息比例随年龄增加逐渐降低。1月龄~6月龄患儿发热比例明显低于其他年龄段患儿(47.2%vs.75.0%~96.8%)。6岁后患儿肺炎比例明显降低;重症肺炎的比例以1月龄~6月龄患儿最高(16.4%)。进入PICU治疗者均为≤2岁患儿。(4)严重程度比较:重症组患儿中位月龄小于轻症组(6月龄vs.13月龄),喘息(90.5%vs.51.4%)、发绀(48.6%vs.1.8%)比例均高于轻症组,热峰低于轻症组(38.2℃vs.39.0℃),早产(P<0.001)及合并先天性心脏病(P=0.019)比例高于轻症组,住院时间长于轻症组。重症组24.7%的患儿转入PICU治疗,21.0%接受呼吸支持。结论2023年广州地区RSV患儿以4~6月份最多,临床表现除呼吸道症状外,呕吐、腹泻等消化道症状也较常见,6月龄以下患儿易进展为重症肺炎。
Background Multiple studies in China have indicated that the COVID-19 pandemic has altered the epidemic pat-tern of respiratory syncytial virus(RSV).Objective To investigate the epidemiological and clinical characteristics of RSV infection among children in Guangzhou in 2023,and to provide a basis for optimizing diagnosis and treatment strategies,as well as for-mulating scientific prevention and control measures for RSV infection.Design Cross-sectional study.Methods A total of 1,091 children aged≤16 years who met the clinical criteria for acute lower respiratory tract infection,tested positive for RSV via throat swab within 48 hours after admission,and required hospitalization were enrolled.They were categorized into a mild infection group and a severe infection group(including severe bronchiolitis and severe pneumonia).Patients with RSV monoinfection were stratified by age,and their epidemiological and clinical features were analyzed.Main outcome measures The severity of RSV infection.Results Among the 1,091 children with RSV infection,674(61.8%)were male and 417 were female.There were 986 mild cases(90.4%)and 105 severe cases.RSV monoinfection was identified in 965 cases(88.4%),while co-infection was found in 126 cases.Underlying diseases were present in 229 cases(21.0%).(1)Monthly distribution:No cases were recorded from January to March.Cases increased to 190(17.4%)in April,peaked at 394(36.1%)in May,decreased to 197(18.1%)in June,and gradually declined to 7(0.6%)by December.(2)Age distribution:Among the 965 children with RSV monoinfection,318(33.0%)were aged 1-6 months,177(18.3%)were>6-12 months,195(20.2%)were>12 months-2 years,221(22.9%)were>2-4 years,38(3.9%)were>4-6 years,and 16(1.7%)were>6 years.(3)Clinical manifestations:The most common symptoms were fever,cough,nasal congestion,runny nose,and wheezing.Gastrointestinal symptoms such as vomiting and diarrhea were also frequently observed.The proportion of wheezing decreased with age.The rate of fever in children aged 1-6 months was significantly lower than that in other age groups(47.2%vs.75.0%-96.8%).The incidence of pneumonia was significantly lower in children over 6 years old.The proportion of severe pneumonia was highest in the 1-6 months age group(16.4%).All patients admitted to the PICU were≤2 years old.(4)Comparison between mild and severe cases:The median age of the severe group was lower than that of the mild group(6 months vs.13 months).The severe group showed higher rates of wheezing(90.5%vs.51.4%),cyanosis(48.6%vs.1.8%),and a higher peak fever temperature(38.2°C vs.39.0°C).Prematurity(P<0.001)and congenital heart disease(P=0.019)were more common in the severe group,and their hospital stays were longer.Of the severe cases,24.7%were transferred to the PICU,and 21.0%required respiratory support.Conclusion In Guangzhou in 2023,RSV infections among children peaked between April and June.Besides respiratory symptoms,gastrointestinal symptoms such as vomiting and diarrhea were relatively common.Children under 6 months old are easy to progress to severe pneumonia.
作者
杨雨明
尹雅斯
王强
刘光明
范晓蔚
YANG Yuming;YIN Yasi;WANG Qiang;LIU Guangming;FAN Xiaowei(Department of Emergency,Guangzhou Women and Children's Medical Center,Guangzhou 510180,China;Department of Pediatric Intensive Care Unit,Guangzhou Women and Children's Medical Center,Guangzhou 510180,China)
出处
《中国循证儿科杂志》
北大核心
2025年第5期355-360,共6页
Chinese Journal of Evidence Based Pediatrics
关键词
呼吸道合胞病毒
儿童
重症肺炎
危险因素
Respiratory syncytial virus
Children
Severe pneumonia
Risk factor
