Clinical features of neonatal severe enterovirus infection
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摘要:
目的 分析新生儿重症肠道病毒感染的临床特点和影响因素。 方法 回顾性分析2019年12月—2020年12月昆明医科大学附属儿童医院收治的76例新生儿肠道病毒感染患儿资料，根据感染严重程度分为普通感染组(63例)和重症感染组(13例)。比较2组患儿临床特征，并采用logistic回归分析研究发生重症肠道病毒感染的危险因素。 结果 与普通感染组患儿相比，重症感染组患儿出生胎龄小、早产儿比例高、起病时间更早，差异有统计学意义(均P＜0.05)；重症感染组患儿白细胞计数异常(＜5×109/L或＞15×109/L)、血小板减低、pH下降、C反应蛋白升高、降钙素原及乳酸升高的发生率高于普通感染组(均P＜0.05)，合并肝功能异常、凝血功能异常、心肌损伤的发生率也高于普通感染组(均P＜0.05)；重症感染组患儿死亡率高于普通感染组(P＜0.05)；多因素logistic回归分析显示，早产(OR=7.125，95% CI：2.275~29.021)、凝血功能异常(OR=22.452，95% CI：2.948~268.656)及pH≤7.25(OR=14.569，95% CI：2.675~40.590)是发生重症肠道病毒感染的独立危险因素。 结论 普通感染和重症感染的新生儿肠道病毒感染患儿临床表现、合并症及实验室检查均存在差异。肠道病毒感染的新生儿如果存在早产、起病时间早、酸中毒、乳酸升高、肝功能异常、凝血功能异常等需警惕重症感染。 Abstract:Objective To analyze the clinical characteristics and influencing factors of neonatal severe enterovirus infection. Methods A retrospective analysis of neonatal enterovirus infection cases admitted to Children' s Hospital Affiliated of Kunming Medical University from December 2019 to December 2020 was performed. Based on the severity of infection, they were divided into the common infection group (n=63) and severe infection group (n=13). The clinical characteristics of the two groups were compared, and the risk factors of severe enterovirus infection were analysed by Logistic regression. Results Compared with the common infection group, the severe infection group had a significantly lower gestational age at birth and a significantly higher proportion of preterm infants and a significantly earlier onset time (P < 0.05). The abnormal white blood cells (< 5×109/L or >15×109/L), thrombocytopenia, pH decrease, C-reactive protein increase, procalcitonin and lactic acid increase were higher than those in the common infection group (all P < 0.05). The incidence of combined liver function abnormality, coagulation function abnormality and myocardial injury was also higher than that of common infection group (all P < 0.05). The mortality of children in severe infection group was higher than that in common infection group (P < 0.05). Multivariate logistic regression analysis showed that preterm birth (OR=7.125, 95% CI: 2.275-29.021), coagulation dysfunction (OR=22.452, 95% CI: 2.948-268.656) and pH ≤ 7.25 (OR=14.569, 95% CI: 2.675-40.590) were the risk factors for severe enterovirus infection. Conclusion Significant differences in clinical manifestations, complications and laboratory tests are observed between the neonates with common and severe enterovirus infection. Neonatal enterovirus infection is accompanied by premature delivery, early onset, acidosis, elevated lactic acid, abnormal liver function, and abnormal blood coagulation function, and it is necessary to be alert to severe infection. -
Key words:
- Enterovirus infection /
- Severe /
- Clinical feature /
- Neonate
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表 1 2组肠道病毒感染患儿临床资料比较
Table 1. Comparison of clinical data between two groups of children with enterovirus infection
组别 例数 早产儿[胎龄＜37周, 例(%)] 出生体重(x±s, kg) 起病时间≤ 7 d[例(%)] 发热[例(%)] 黄疸[例(%)] 呼吸道症状[例(%)] 消化道症状[例(%)] 皮疹[例(%)] 惊厥[例(%)] 死亡[例(%)] 普通感染组 63 7(11.1) 3.08±0.43 20(31.7) 22(34.9) 32(50.8) 21(33.3) 17(27.0) 10(15.9) 2(3.2) 0 重症感染组 13 6(46.2) 2.64±0.77 9(69.2) 8(61.5) 6(46.2) 7(53.8) 7(53.8) 2(15.4) 2(15.4) 2(15.4) 统计量 7.250a 1.988b 4.926a 3.196a 0.093a 1.167a 2.463a <0.001a 1.239a P值 0.008 0.063 0.026 0.074 0.761 0.280 0.117 0.999 0.266 0.028c 注：a为χ2值，b为t值, c为采用Fisher精确检验。 
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表 2 2组肠道病毒感染患儿入院首次实验室检查指标比较[例(%)]
Table 2. Comparison of first laboratory examination indexes of enterovirus infection between two groups[cases (%)]
组别 例数 血白细胞计数异常 血小板＜150×109/L C-反应蛋白≥ 10 mg/L 降钙素原≥ 0.5 mg/L pH≤7.25 乳酸＞2.6 mmol/L 脑脊液白细胞＞21×106/L 肝功能异常 凝血功能异常 心肌损伤 普通感染组 63 21(33.3) 7(11.1) 22(34.9) 19(30.2) 8(12.7) 21(33.3) 8(12.7) 6(9.5) 5(7.9) 9(14.3) 重症感染组 13 10(76.9) 9(69.2) 10(76.9) 9(69.2) 9(69.2) 11(84.6) 5(38.5) 7(53.8) 11(84.6) 6(46.1) χ2值 8.478 18.544 7.799 5.491 16.711 11.626 3.391 11.968 33.648 5.043 P值 0.004 <0.001 0.005 0.019 <0.001 0.001 0.066 0.001 <0.001 0.025
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表 3 变量赋值表
Table 3. Variable assignment table
变量 赋值方法 肠道病毒感染 重症感染组=1，普通感染组=0 早产儿 早产儿=1，非早产儿=0 起病时间 日龄≤7 d=1，日龄＞7 d=0 白细胞计数 异常=1，正常=0 血小板计数 减低=1，不减低=0 C反应蛋白 升高=1，正常=0 降钙素原 升高=1，正常=0 乳酸 ＞2.6 mmol/L=1, ≤2.6 mmol/L=0 pH值 pH≤7.25=1，pH＞7.25=0 肝功能 异常=1，正常=0 凝血功能 异常=1，正常=0 心肌酶 异常=1，正常=0
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表 4 发生重症肠道病毒感染的多因素logistic回归分析
Table 4. Multivariate logistic regression analysis of severe enterovirus infection
变量 B SE Wald χ2 P值 OR值 95% CI 早产儿 -1.925 0.686 7.883 0.005 7.125 2.275~29.021 凝血功能异常 -4.343 1.229 13.906 0.001 22.452 2.948~268.656 pH≤7.25 -2.985 1.170 6.510 0.011 14.569 2.675~40.590 注：表中仅列出P < 0.05的变量。
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