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朱慧慧, 吕芳芳, 徐铭, 等. 儿童百日咳的临床特征研究及诊断标准探讨[J]. 四川大学学报(医学版), 2021, 52(5): 839-843. DOI: 10.12182/20210960104
引用本文: 朱慧慧, 吕芳芳, 徐铭, 等. 儿童百日咳的临床特征研究及诊断标准探讨[J]. 四川大学学报(医学版), 2021, 52(5): 839-843. DOI: 10.12182/20210960104
ZHU Hui-hui, LÜ Fang-fang, XU Ming, et al. Discussions on Clinical Characteristics and Diagnostic Criteria of Pertussis in Children[J]. Journal of Sichuan University (Medical Sciences), 2021, 52(5): 839-843. DOI: 10.12182/20210960104
Citation: ZHU Hui-hui, LÜ Fang-fang, XU Ming, et al. Discussions on Clinical Characteristics and Diagnostic Criteria of Pertussis in Children[J]. Journal of Sichuan University (Medical Sciences), 2021, 52(5): 839-843. DOI: 10.12182/20210960104

儿童百日咳的临床特征研究及诊断标准探讨

Discussions on Clinical Characteristics and Diagnostic Criteria of Pertussis in Children

  • 摘要:
      目的  比较温州地区不同年龄及不同免疫状态儿童百日咳的临床特征,并探讨儿童百日咳诊断标准的局限性。
      方法  回顾性分析2017年10月−2019年12月温州医科大学附属第二医院育英儿童医院住院确诊的288例百日咳患儿的临床资料,分析不同年龄和不同免疫状态患儿的临床特征,分析《中国儿童百日咳诊断及治疗建议》相关标准对不同年龄段百日咳患儿的诊断符合率。
      结果  288例患儿中,≤3月龄124例(43.06%),>3月龄164例(56.94%)。≤3月龄与>3月龄相比,发绀、三凹征、面色涨红、气促和外周血淋巴细胞比例均较高,发生肺炎的比例较高,重症百日咳比例较高,住院天数较长,上述差异均有统计学意义(P<0.05)。完全免疫组83例,未完全免疫组205例。未完全免疫组出现发绀、气促、三凹征和面色涨红的比例高于完全免疫组,且未完全免疫组淋巴细胞比例高于完全免疫组,血清C-反应蛋白(C-reactive protein, CRP)水平低于完全免疫组,住院时间长于完全免疫组,上述差异均有统计学意义(P<0.05)。≤3月龄入院时临床标准的诊断符合率(112/124,90.32%)高于>3月龄(119/164,72.56%)(P<0.001);≤3月龄患儿入院时符合外周血白细胞计数≥20×109 L−1且淋巴细胞比例≥60%的比例为41.94%(52/124),白细胞计数<20×109 L−1所占比例为54.03%(67/124)。
      结论  温州地区≤3月龄的百日咳患儿病情较重,临床标准诊断符合率大于>3月龄。≤3月龄血常规白细胞计数的阈值可适当下调,现行诊断标准尚待完善。

     

    Abstract:
      Objective  To compare the clinical manifestations of pertussis in children of different ages and different immunization statuses in Wenzhou, and to explore the limitations of diagnostic criteria for pertussis.
      Methods  The clinical data of 288 children diagnosed with pertussis at Yuying Children’s Hospital & the Second Affiliated Hospital of Wenzhou Medical University from October 2017 to December 2019 were retrospectively analyzed. The clinical characteristics of children of different ages and different immunization statuses were analyzed. Their clinical data were compared to relevant diagnostic criteria of pertussis in children of different ages according to the Recommendations for Diagnosis and Treatment of Chinese Children with Pertussis and the diagnosis conformity rate was analyzed.
      Results   Among the 288 children, 124 cases (43.06%) were 3 months old or younger, and 164 cases (288, 56.94%) were >3 months old. Among patients≤3 months of age, cyanosis, three-depression sign, face redness, dyspnea and peripheral blood lymphocyte ratio were significantly higher than those of patients >3 months of age. They also had higher incidence of pneumonia, higher proportion of developing severe pertussis, and longer stay at the hospital. All these findings showed statistically significant difference (P<0.05). 83 children were fully immunized (receiving the full course of vaccination), and 205 were not fully immunized (not receiving the full course of vaccination or being unvaccinated). The proportion of children presenting cyanosis, shortness of breath, three depression sign and face redness in the incomplete immunization group was higher than that in the complete immunization group. In the incomplete immunization group, the proportion of lymphocytes was higher, the level of C-reactive protein (CRP) was lower, and the length of hospitalization was longer than those of the complete immunization group. All the differences were statistically significant (P<0.05). Among patients aged ≤3 months, the conformity rate of diagnosis (112/114, 90.32%) upon admission was higher than that among patients aged >3 months (119/164, 72.56%). Among patients aged ≤3 months, 41.94% (52/124, while 54.03% (67/124) of the patients aged ≤3 months had WBC count <20×109 L−1.
      Conclusion  Pertussis in children ≤3 months of age in Wenzhou City were more serious, showing higher rate of diagnosis conforming to the recommended clinical diagnostic criteria than that in children >3 months old. The WBC threshold in routine blood test of ≤3 months old could be lowered appropriately and the current diagnostic criteria still needed improvement.

     

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