南京地区儿童百日咳住院病例临床特征及预后分析-现代医学

南京地区儿童百日咳住院病例临床特征及预后分析

单位：南京医科大学附属儿童医院呼吸科, 江苏南京 210019

分类号：R725.1

出版年·卷·期（页码）：2025·53·第二期（258-264）

摘要：

目的：百日咳目前仍然是全球公共卫生威胁之一，近年来病例有所增加，婴幼儿和未接种疫苗人群是主要患病群体。本研究旨在分析描述南京地区百日咳患儿的常规血液和病原学检查结果，寻找影响预后的重要因素。方法：本研究采用回顾性研究设计，纳入2014年1月至2024年6月在南京医科大学附属儿童医院就诊并确诊为百日咳的儿童。利用随机森林模型寻找与儿童百日咳预后相关的特征因素。结果：研究共纳入123例百日咳患儿，其中男62例(50.40%)，女61例(49.60%)。患儿中位数年龄为0.38岁，其中86例未满1岁(69.90%)。肺炎支原体(MP)合并感染率最高(13.80%)。血小板(PLT)的平均值为(513.73±170.56)×10⁹·L^-1，范围在113.00～911.00×10⁹·L^-1；淋巴细胞(LYMPH)的平均值为(12.09±7.39)×10⁹·L^-1，范围在0.90～30.53×10⁹·L^-1；胱抑素C (Cys-c)的平均值为(1.22±0.34) mg·L^-1，范围在0.63～2.40 mg·L^-1。随机森林模型分析显示，PLT是预测儿童百日咳预后最重要的特征因素，其次是LYMPH和Cys-c。总体模型的袋外误差率(OOB Error)为12.20%，曲线下面积(AUC)为0.783。结论： PLT、LYMPH、Cys-c可能是预测儿童百日咳预后的重要特征因素。

Objective: Pertussis remains a global public health threat, with cases increasing in recent years, mainly among infants and unvaccinated people. The purpose of this study was to analyze and describe the results of routine blood and etiology examination of children with pertussis in Nanjing area, and to find the important factors influencing the prognosis. Methods: Retrospective study design was used to include children diagnosed with pertussis who were admitted to the Children's Hospital of Nanjing Medical University from January 2014 to June 2024. The random forest model was used to find the characteristic factors associated with the prognosis of pertussis in children. Results: A total of 123 children with pertussis were included in the study, including 62 males(50.40%) and 61 females(49.60%). The median age of the patients was 0.38 years, of whom 86(69.90%) were less than 1 year old. Mycoplasma pneumoniae(MP) had the highest co-infection rate(13.80%). The mean value of platelets(PLT) was 513.73±170.56×10⁹·L^-1, ranging from 113.00 to 911.00×10⁹·L^-1. The average LYMPH score was 12.09±7.39×10⁹·L^-1, and the lymph score ranged from 0.90 to 30.53×10⁹·L^-1. The mean value of cystatin C(Cys-c) was 1.22±0.34 mg·L^-1, ranging from 0.63 to 2.40 mg·L^-1. Random forest model analysis showed that PLT was the most important characteristic factor for predicting the prognosis of pertussis in children, followed by LYMPH and Cys-c. The overall model has an out-of-pocket Error rate(OOB) of 12.20% and an area under the curve(AUC) of 0.783. Conclusion: PLT, LYMPH and Cys-c may be important prognostic factors for children with pertussis.

参考文献：

[1] PLUTA R M,LYNM C,GLASS R M.JAMA patient page.Pertussis[J].JAMA,2010,304(8):922.
[2] YEUNG K H T,DUCLOS P,NELSON E A S,et al.An update of the global burden of pertussis in children younger than 5 years:a modelling study[J].Lancet Infect Dis,2017,17(9):974-980.
[3] Global burden of 369 diseases and injuries in 204 countries and territories,1990-2019:a systematic analysis for the Global Burden of Disease Study 2019[J].Lancet (London,England),2020,396(10258):1204-1222.
[4] 张倩,吴丹,郑徽,等.中国2022年百日咳流行病学特征[J].中国疫苗和免疫,2024,30(1):34-38.
[5] ZHANG Z,PAN J,CHEN M,et al.Seroepidemiology of pertussis in China:a population-based,cross-sectional study[J].Vaccine,2021,39(12):1687-1692.
[6] 董琴琴,吴维仪,梁明欣,等.儿童百日咳的诊治进展[J].现代临床医学,2024,50(3):219-222.
[7] 张艳炜,梁静,卢紫燕,等.不同免疫状态和年龄对百日咳患儿临床表现的影响[J].中华传染病杂志,2020,38(7):440-443.
[8] CARVALHO C F A,ANDREWS N,DABRERA G,et al.National outbreak of pertussis in England,2011-2012:a case-control study comparing 3-component and 5-component acellular vaccines with whole-cell pertussis vaccines[J].Clin Infect Dis,2020,70(2)200-207.
[9] DALBY T,ANDERSEN P H,HOFFMANN S.Epidemiology of pertussis in Denmark,1995 to 2013[J].Eurosurveillance,2016,21(36):30334.
[10] NING G,GAO Y,WU D,et al.Epidemiology of pertussis in China,2011-2017[J].Chin J Vaccines Immun,2018,24(3):264-267.
[11] SKOFF T H,HADLER S,HARIRI S.The epidemiology of nationally reported pertussis in the United States,2000-2016[J].Clin Infec Dis,2019,68(10):1634-1640.
[12] ZHANG Q,HAN F,NIE Q,et al.Seroprevalence of antibodies to pertussis and diphtheria among healthy adults in China[J].J Infection,2011,63(6):441-446.
[13] 康小娟,彭晓康,李亚绒,等.儿童百日咳痉挛性咳嗽演变与白细胞和淋巴细胞水平的关系[J].中国妇幼健康研究,2023,34(8):63-69.
[14] 罗晶晶,黎耀文,田晓旭,等.283例儿童百日咳住院病例临床特征及重症百日咳相关危险因素分析[J].新发传染病电子杂志,2024,9(3):5-10.
[15] 张继燕,卓裕霏,陈艳萍,等.儿童百日咳住院病例248例临床特征及重症百日咳相关危险因素分析[J].中华实用儿科临床杂志,2023,38(4):275-280.
[16] VANDERENDE K,GACIC-DOBO M,DIALLO M S,et al.Global routine vaccination coverage-2017[J]. MMWR Morb Mortal Wkly Rep,2018,67(45):1261-1264.
[17] YU J,HE H,ZHANG Y,et al.Burden of whooping cough in China (Pertussis China):study protocol of a prospective,population-based case-control study[J].BMJ Open,2022,12(3):e053316.
[18] KANG L,CUI X,FU J,et al.Clinical characteristics of 967 children with pertussis:a single-center analysis over an 8-year period in Beijing,China[J].Eur J Clin Microbiol,2022,41(1):9-20.
[19] BECHINI A,TISCIONE E,BOCCALINI S,et al.Acellular pertussis vaccine use in risk groups (adolescents,pregnant women,newborns and health care workers):a review of evidences and recommendations[J].Vaccine,2012,30(35):5179-5190.
[20] BIRRU F,AL-HINAI Z,AWLAD THANI S,et al.Critical pertussis:a multi-centric analysis of risk factors and outcomes in Oman[J].IJID,2021,107:53-58.
[21] 宋春燕,关宇凤.血小板计数水平与肺炎患儿病情严重程度的关系[J].泰山医学院学报,2017(9):2.
[22] 王婧文,王学莲,底建辉.儿童社区获得性肺炎血清MLR、PLR与疾病严重程度的相关性及危险因素分析[J].中国实验诊断学,2023,27(10):1170-1174.
[23] 张林.婴幼儿呼吸道合胞病毒毛细支气管炎复发喘息相关危险因素分析及趋化因子表达的临床意义探讨[D].苏州:苏州大学,2023.
[24] 樊华峰,陈媛,徐鹏飞,等.中性粒细胞与淋巴细胞比值在儿童流感重症化中的价值[J].检验医学与临床,2022,19(13):1824-1827.
[25] 于芹.儿童流行性感冒相关死亡病例临床特点及危险因素分析[D].沈阳:中国医科大学,2021.
[26] 朱小健,万浩,余倩.白细胞衍生性指标在儿童肺炎严重程度及预后评估中的应用观察[J].实用医技杂志,2024,31(5):360-365.
[27] 赵艳,汤磊,尹丽娟,等.基于临床特征的儿童重症百日咳早期预警危险因素Meta分析[J].中国疫苗和免疫,2020,26(4):460-467.
[28] 雷伟,李发富.胱抑素C儿童急性肾损伤病情评估与价值分析[J].国际检验医学杂志,2015,36(14):2002-2004.
[29] 陈正徐,王秀丽,饶晓红,等.血、尿胱抑素C检测对小儿肺炎肾功能监测的临床研究[J].实验与检验医学,2012,30(3):236-238.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录