巨细胞病毒感染对婴儿百日咳病情的影响

陈乐园; 王要; 何丽婷; 潘家华; 张兰

doi:10.16766/j.cnki.issn.1674-4152.003287

巨细胞病毒感染对婴儿百日咳病情的影响

doi: 10.16766/j.cnki.issn.1674-4152.003287

陈乐园¹,
王要²,
何丽婷²,
潘家华³,
张兰^{1, 3, ,}

1.
蚌埠医学院研究生院，安徽蚌埠 233000
2.
安徽医科大学研究生院，安徽合肥 230000
3.
中国科学技术大学附属第一医院(安徽省立医院)儿科，安徽合肥 230000

基金项目:

安徽省教育厅基金项目 2021jyxm1760

详细信息

通讯作者:
张兰，E-mail：zhanglan1978@ustc.edu.cn

中图分类号: R725.1 R373.1
计量
- 文章访问数: 84
- HTML全文浏览量: 39
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2023-03-13
- 网络出版日期: 2024-01-29

Clinical observation of the effect of cytomegalovirus infection on pertussis in infants

1.
Department of Pediatrics, Graduate School of Bengbu Medical College, Bengbu, Anhui 233000, China

摘要

摘要: 目的探讨巨细胞病毒(CMV)感染对百日咳患儿的临床表现、病程以及病情严重程度的影响。方法回顾性分析2015年4月—2019年12月中国科学技术大学附属第一医院儿科病房收治的241例百日咳患儿的临床资料，根据是否合并CMV感染分为观察组(合并CMV感染，80例)和对照组(未合并CMV感染，161例)。采集患儿的临床资料，包括性别、年龄、入院前发病时间、咳嗽接触史、接种疫苗史、鼻塞、流涕、打喷嚏、夜间咳嗽、痉挛性咳嗽、咳嗽后呕吐、咳嗽后面红、喘息、气促、呼吸暂停、发热、肺部啰音、肺炎、住院时间、咳嗽症状持续时间、白细胞总数值、肝功能、胸部X线正位片及胸部CT。分析比较2组患儿的上述指标。结果观察组患儿的气促发生率明显高于对照组[3.75%(3/80) vs. 0, P=0.036]，且观察组患儿的咳嗽症状持续时间[8.50(6.00, 11.00)d vs. 7.00(4.00, 9.00)d, Z=-3.632, P < 0.001]和住院时间[11.00(8.00, 13.00)d vs. 8.00(6.00, 10.00)d, Z=-5.026, P < 0.001]均明显长于对照组。2组临床表现和体征包括鼻塞、流涕、打喷嚏、夜间咳嗽、痉挛性咳嗽、咳嗽后呕吐、咳嗽后面红、喘息、呼吸暂停、发热、肺部啰音及肺炎，差异均无统计学意义(均P＞0.05)；2组白细胞总数值、肝功能及影像学表现比较，差异均无统计学意义(均P＞0.05)。结论 CMV感染可在一定程度上加重患儿病情严重程度和延长婴儿百日咳的病程。
- 婴儿 /
- 百日咳 /
- 巨细胞病毒 /
- 病情
Abstract: Objective To investigate the effect of cytomegalovirus (CMV) infection on the clinical presentation, duration of illness, and severity of illness in children with pertussis. Methods A retrospective analysis was conducted on 241 children with pertussis who were admitted to the paediatric ward of the First Affiliated Hospital of the University of Science and Technology of China from April 2015 to December 2019. They were divided into an observation group of 80 cases (with CMV infection) and a control group of 161 cases (without CMV infection) based on whether they had CMV infection. Clinical data of the patients were collected, including gender, age, days of onset before admission, history of cough contact, vaccination history, nasal congestion, runny nose, sneezing, nocturnal cough, spasmodic cough, vomiting after coughing, redness after coughing, wheezing, shortness of breath, apnoea, fever, lung rales, pneumonia, length of hospital stay, duration of cough symptoms, total white blood cell count, liver function, chest X-ray and chest CT. The attractiveness indicators of two groups of children were analyzed. Results The incidence of shortness of breath [3.75%(3/80) vs. 0, P=0.036] was significantly higher in the observation group than in the control group, and the duration of cough symptoms [8.50 (6.00, 11.00) d vs. 7.00 (4.00, 9.00) d, Z=-3.632, P < 0.001] and hospitalization time [11.00 (8.00, 13.00) d vs. 8.00 (6.00, 10.00)d, Z=-5.026, P < 0.001] were significantly longer in the observation group than in the control group. Comparing the clinical manifestations and signs of nasal congestion, runny nose, sneezing, nocturnal cough, spasmodic cough, post-cough vomiting, post-cough redness, wheezing, apnoea, fever, lung rales, and pneumonia between the two groups, there were no statistically significant difference (all P > 0.05). There were no significant difference in total white blood cell count, liver function and imaging findings (all P > 0.05). Conclusion CMV infection may prolong the duration of pertussis in infants.
- Infant /
- Pertussis /
- Cytomegalovirus /
- The disease

HTML全文

表 1 2组百日咳患儿一般资料比较

Table 1. Comparative analysis of general data in two groups of children with pertussis

组别	例数	性别(例)		月龄 [M(P₂₅, P₇₅)，月]	入院前发病时间 [M(P₂₅, P₇₅)，d]	咳嗽接触史 [例(%)]	接种疫苗史 [例(%)]
组别	例数	男	女	月龄 [M(P₂₅, P₇₅)，月]	入院前发病时间 [M(P₂₅, P₇₅)，d]	咳嗽接触史 [例(%)]	接种疫苗史 [例(%)]
观察组	80	45	35	3.89(3.00, 5.58)	15.00(10.00, 20.00)	31(38.75)	27(33.75)
对照组	161	91	70	3.93(2.50, 6.33)	15.00(10.00, 20.00)	47(29.19)	64(39.75)
统计量		0.002^a		-0.002^b	-0.473^b	2.230^a	0.819^a
P值		0.968		0.998	0.636	0.135	0.365
注：^a为χ²值，^b为Z值。

下载: 导出CSV

表 2 2组百日咳患儿临床症状、体征与住院时间比较

Table 2. Comparative analysis of clinical symptoms, signs, and hospitalization time in two groups of children with pertussis

组别	例数	鼻塞、流涕、打喷嚏[例(%)]	夜间咳嗽 [例(%)]	痉挛性咳嗽 [例(%)]	咳嗽后呕吐 [例(%)]	咳嗽后面红 [例(%)]	喘息 [例(%)]	气促 [例(%)]
观察组	80	20(25.00)	52(65.00)	39(48.75)	24(30.00)	64(80.00)	15(18.75)	3(3.75)
对照组	161	30(18.63)	108(67.08)	89(55.28)	49(30.43)	128(79.50)	41(25.47)	0
统计量		1.317^a	0.104^a	0.915^a	0.005^a	0.008^a	1.351^a
P值		0.251	0.747	0.339	0.945	0.928	0.245	0.036^b

组别	例数	呼吸暂停 [例(%)]	发热 [例(%)]	肺部啰音 [例(%)]	肺炎 [例(%)]	住院时间 [M(P₂₅, P₇₅), d]	咳嗽症状持续时间 [M(P₂₅, P₇₅), d]
观察组	80	26(32.50)	21(26.25)	38(47.50)	33(41.25)	11.00(8.00, 13.00)	8.50(6.00, 11.00)
对照组	161	55(34.16)	35(21.74)	82(50.93)	52(32.30)	8.00(6.00, 10.00)	7.00(4.00, 9.00)
统计量		0.066^a	0.610^a	0.252^a	1.876^a	-5.026^c	-3.632^c
P值		0.797	0.435	0.616	0.171	< 0.001	< 0.001
注：^a为χ²值，^b为采用Fisher精确检验，^c为Z值。

下载: 导出CSV

表 3 2组百日咳患儿实验室指标及影像学检查比较[例(%)]

Table 3. Comparative analysis of laboratory and imaging examinations in two groups of children with pertussis [cases(%)]

组别	例数	异常白细胞总数	异常肝功能	异常影像学检查
观察组	80	12/78(15.38)	10/80(12.50)	12/39(30.77)
对照组	161	25/155(16.13)	15/161(9.32)	32/98(32.65)
χ²值		0.022	0.583	0.045
P值		0.883	0.445	0.831

下载: 导出CSV

参考文献(28)

[1]	中华预防医学会, 中华预防医学会疫苗与免疫分会, 徐爱强, 等. 中国百日咳行动计划专家共识[J]. 中国疫苗和免疫, 2021, 27(3): 317-327. Chinese Preventive Medicine Association, Vaccine and Immunology Branch of the Chinese Preventive Medicine Association, XU A Q, et al. Expert consensus on the China pertussis initiative[J]. Chinese Journal of Vaccines and Immunization, 2021, 27(3): 317-327.
[2]	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. ZHU H H, LYU F F, ZHANG H L, et al. Discussions on clinical characteristics and diagnostic criteria of pertussis in children[J]. Journal of Sichuan University (Medical Science Edition), 2021, 52(5): 839-843.
[3]	MBAYEI S A, FAULKNER A, MINER C, et al. Severe pertussis infections in the United States, 2011-2015[J]. Clin Infect Dis, 2019, 69(2): 218-226. doi: 10.1093/cid/ciy889
[4]	邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 北京: 人民卫生出版社, 2018: 481-483. SHAO X M, YE H M, QIU X S. Practice of neonatology[M]. Beijing: People's Medical Publishing House, 2018: 481-483.
[5]	毛静. 小婴儿巨细胞病毒(CMV)感染的临床特点及诊治[J]. 中外女性健康研究, 2018(2): 21-23. MAO J. Clinical features and diagnosis of cytomegalovirus(CMV)infection in small infants[J]. Women's Health Research, 2018(2): 21-23.
[6]	杨林, 吴诗品. 先天性人巨细胞病毒感染的防治进展[J]. 新发传染病电子杂志, 2020, 5(2): 131-135. doi: 10.3877/j.issn.2096-2738.2020.02.016 YANG L, WU S P. Prevention and treatment progress of congenital human cytomegalovirus infection[J]. Electronic Journal of Emerging Infectious Diseases, 2020, 5(2): 131-135. doi: 10.3877/j.issn.2096-2738.2020.02.016
[7]	徐水宝, 卢洪洲. 先天性巨细胞病毒感染的研究进展[J]. 微生物与感染, 2022, 17(2): 123-128. XU S B, LU H Z. Research progress of congenital cytomegalovirus infection[J]. Journal of Microbes and Infections, 2022, 17(2): 123-128.
[8]	中华人民共和国卫生部. WS274-2007百日咳诊断标准[S]. 北京: 中国标准出版社, 2007: 1-8. Ministry of Health of the People's Republic of China. Diagnostic criteria for pertussis: WS274－2007[S]. Beijing: Stand Press of China, 2007: 1-8.
[9]	中华医学会儿科学分会感染学组, 全国临床病毒感染协作组, 《中华儿科杂志》编辑委员会. 儿童巨细胞病毒性疾病诊断和防治的建议[J]. 中华儿科杂志, 2012, 50(4): 290-292. Infection Group of Pediatric Branch of Chinese Medical Association, National Clinical Viral Infection Cooperation Group, Editorial Committee of Chinese Journal of Pediatrics. Suggestions for diagnosis and treatment of cytomegalovirus diseases in children[J]. Chinese Journal of Pediatrics, 2012, 50(4): 290-292.
[10]	周秀琴, 杨朝艳, 艾莉莉. 阿奇霉素与依托红霉素治疗百日咳的疗效比较[J]. 人人健康, 2019, 496(11): 249. ZHOU X Q, YANG Z Y, AI L L. Comparison of azithromycin and etoerythromycin in the treatment of pertussis[J]. Health Everyone, 2019, 496(11): 249.
[11]	郑云霞. 阿奇霉素与依托红霉素治疗百日咳的疗效比较[J]. 数理医药学杂志, 2020, 33(10): 1539-1540. ZHENG Y X. A Comparison between the efficacy of Azithromycin and Erythromycin on pertussis[J]. Journal of Mathematical Medicine, 2020, 33(10): 1539-1540.
[12]	王宗润, 米荣. 百日咳研究现状[J]. 当代医学, 2018, 24(6): 174-177. doi: 10.3969/j.issn.1009-4393.2018.06.081 WANG Z R, MI R. Research status of pertussis[J]. Contemporary Medicine, 2018, 24(6): 174-177. doi: 10.3969/j.issn.1009-4393.2018.06.081
[13]	李虹, 杨婷婷, 陈霄, 等. 2016—2017年山西省健康人群百日咳抗体水平监测[J]. 实用医技杂志, 2019, 26(10): 1282-1283. LI H, YANG T T, CHEN X, et al. Surveillance of pertussis antibody levels in healthy population in Shanxi Province from 2016 to 2017[J]. Journal of Practical Medical Techniques, 2019, 26(10): 1282-1283.
[14]	杨婷婷. 山西省2015—2020年百日咳流行特征分析[J]. 实用医技杂志, 2021, 28(10): 1227-1228. YANG T T. Epidemiological characteristics of whooping cough in Shanxi Province from 2015 to 2020[J]. Journal of Practical Medical Techniques, 2021, 28(10): 1227-1228.
[15]	王文雯, 吴德, 唐久来. 巨细胞病毒感染对全面性发育迟缓婴幼儿听力、智力及运动功能发育的影响[J]. 山东医药, 2018, 58(29): 17-19. WANG W W, WU D, TANG J L. Effects of human cytomegalovirus infection on hearing, intelligence, and motor function in infants with global developmental delay[J]. Shandong Medical Journal, 2018, 58(29): 17-19.
[16]	朱艳, 周灵玲, 蓝俊伟, 等. 人巨细胞病毒DNA检测在小儿人巨细胞病毒感染诊断中的应用[J]. 中华全科医学, 2020, 18(3): 460-462, 466. doi: 10.16766/j.cnki.issn.1674-4152.001273 ZHU Y, ZHOU L L, LAN J W, et al. Application of human cytomegalovirus DNA detection in diagnosis of human cytomegalovirus infection in children[J]. Chinese Journal of General Practice, 2020, 18(3): 460-462, 466. doi: 10.16766/j.cnki.issn.1674-4152.001273
[17]	中华预防医学会, 中华预防医学会疫苗与免疫分会. 中国百日咳行动计划专家共识[J]. 中国公共卫生, 2021, 37(6): 905-914. Chinese Preventive Medicine Association, Vaccine and Immunology Branch of the Chinese Preventive Medicine Association. Expert consensus on the China Pertussis Initiative[J]. Chinese Journal of Public Health, 2021, 37(6): 905-914.
[18]	陈慧中, 陈志敏, 洪建国, 等. 儿童常见喘息性疾病抗病原微生物药物合理应用专家共识[J]. 中国实用儿科杂志, 2020, 35(12): 918-926. CHEN H Z, CHEN Z M, HONG J G, et al. Expert consensus on rational use of antimicrobial drugs in children with common wheezing diseases[J]. Chinese Journal of Practical Pediatrics, 2020, 35(12): 918-926.
[19]	SUN H, LI S, YAN Y, et al. Associations between patient clinical characteristics and the presence of cytomegalovirus DNA in the bronchoalveolar lavage fluid of children with recurrent wheezing[J]. BMC Infect Dis, 2018, 18(1): 458. doi: 10.1186/s12879-018-3345-9
[20]	AMIYA S, HIRATA H, SHIROYAMA T, et al. Fatal cytomegalovirus pneumonia in a critically ill patient with COVID-19[J]. Respirol Case Rep, 2021, 9(7): e00801. DOI: 10.1002/rcr2.801.
[21]	邹春山, 郑铭城, 谢楠楠, 等. 百日咳患儿免疫水平及其危重因素分析[J]. 中国医药指南, 2021, 19(23): 23-25. ZHOU C S, ZHENG M C, XIE N N, et al. Analysis of immune level and critical factors in children with pertussis[J]. Guide of China Medicine, 2021, 19(23): 23-25.
[22]	ALYAZIDI R, MURTHY S, SLYKER J A, et al. The potential harm of cytomegalovirus infection in immunocompetent critically ill children[J]. Front Pediatr, 2018, 6: 96. doi: 10.3389/fped.2018.00096
[23]	彭晓康, 刘小乖, 李亚绒, 等. 合并其他病原感染的百日咳患儿临床特征与炎症指标特点[J]. 中国妇幼健康研究, 2020, 31(8): 1089-1093. PENG X K, LIU X G, LI Y R, et al. Clinical manifestations and inflammatory indicators of children with pertussis complicated with other pathogens[J]. Chinese Journal of Woman and Child Health Research, 2020, 31(8): 1089-1093.
[24]	BAROUDY N R E, REFAY A S E, HAMID T A A, et al. Respiratory viruses and atypical bacteria co-infection in children with acute respiratory infection[J]. Open Access Maced J Med Sci, 2018, 6(9): 1588-1593. doi: 10.3889/oamjms.2018.332
[25]	杜爽, 芦起. 小婴儿百日咳的临床研究进展[J]. 儿科药学杂志, 2022, 28(4): 62-66. DU S, LU Q. Progress of pertussis in infants[J]. Journal of Pediatric Pharmacy, 2022, 28(4): 62-66.
[26]	白亮亮, 陈家辉, 王丽丹, 等. 淮北市3224例肺炎患儿病例流行特征及住院时间分析[J]. 安徽医学, 2022, 43(1): 32-35. BAI L L, CHEN J H, WANG L D. Epidemiological characteristics of 3224 hospitalized children with pneumonia in Huaibei city[J]. Anhui Medical Journal, 2022, 43(1): 32-35.
[27]	张维娜, 丁传刚, 赵红英, 等. 巨细胞病毒性肝炎患儿血清IFN-γ和IL-18水平变化及其与预后的关系探讨[J]. 实用肝脏病杂志, 2021, 24(2): 208-211. ZHANG W N, DING C G, ZHAO H Y, et al. Changes of serum IFN-γand IL-18 levels in children with cytomegalovirus hepatitis[J]. Journal of Practical Hepatology, 2021, 24(2): 208-211.
[28]	王静娟, 庞琳, 米荣, 等. 儿童百日咳临床特征及重症百日咳危险因素分析[J]. 中国实用儿科杂志, 2021, 36(12): 941-946. WANG J J, PANG L, MI R, et al. Clinical characteristics of pertussis in children and risk factors for severe pertussis[J]. Chinese Journal of Practical Pediatrics, 2021, 36(12): 941-946.