儿童新冠病毒Omicron株感染临床特征及其影响因素

doi:10.12372/jcp.2022.22e0848

摘要/Abstract

摘要：

目的探讨儿童新冠病毒Omicron株感染临床特征及其相关影响因素。方法收集94例Omicron株感染患儿的临床表现、实验室检查、肺部CT影像、核酸检测、临床分型、疫苗接种和诊治疗效等资料进行分析总结。结果 94例中男51例（54.3%）、女43例,年龄9天~14岁（平均4.5±3.3岁）,接种过疫苗33例。所有患儿均有与Omicron感染病例密切接触史。无症状与轻症占76.6%。肺炎组患儿外周血淋巴细胞绝对计数均值（2.66×10⁹/L）显著低于无症状/轻症组（4.18×10⁹/L）,P=0.024。疫苗接种与未接种患儿比较,无症状与轻症占比显著增高（90.9%对68.9%,P=0.013）,发热人数明显减少（42.4%对70.5%,P=0.008）,平均住院天数明显缩短（P=0.026）;ORF1ab与N基因C_t值均高于未接种者（P均<0.05）。以中药汤剂经典处方加减行个体化辨证施治,联合经验性抗生素（头孢菌素或大环内酯类）治疗后患儿均痊愈,平均住院（8.5±3.8）天。1例重症患儿经积极抗继发感染、抗凝和短程糖皮质激素等综合治疗,病情得以及时控制。结论儿童对于Omicron株普遍易感,疫苗接种有助于提高特异性免疫力,故加强隔离防护和疫苗接种,均为预防儿童Omicron感染的有效措施。

关键词: Omicron株, 临床特征, 疫苗, 影响因素, 儿童

Abstract:

Objective To explore the clinical characteristics and related factors of SARS-CoV-2 Omicron variant infection in children. Methods The clinical manifestations, laboratory tests, pulmonary CT imaging, nucleic acid detection, clinical typing, vaccination and therapeutic efficacy of 94 children with Omicron infection were analyzed and summarized. Results A total of 94 children were enrolled, including 51 boys (54.3%) and 43 girls, aged from 9 days to 14 years (mean, 4.5±3.3 years), 33 of whom had been vaccinated. All children had a history of close contact with Omicron infected patients. Asymptomatic and mild cases accounted for 76.6%. The mean value of peripheral blood absolute lymphocyte count in pneumonia group was 2.66×10⁹/L, which was significantly lower than that (4.18×10⁹/L) in asymptomatic/mild group (P=0.024). Compared with non-vaccinated group, the proportion of asymptomatic and mild cases was significantly higher (90.9% vs 68.9%, P=0.013), the number of children with fever was lower (42.4% vs 70.5%, P=0.008), and the average length of hospital stay was significantly shorter (P=0.026) in vaccinated group. The C_t values of ORF1ab and N gene in vaccinated group were significantly higher than those in non-vaccinated group (P<0.05). Individualized syndrome differentiation and treatment was carried out by adding or subtracting classic prescription of traditional Chinese medicine decoction and empiric antibiotics (cephalosporins or macrolides) were administered in combination. All patients recovered, and the average hospital stay was (8.5±3.8) days. One severe case was controlled in time by comprehensive therapy including active anti-secondary infection, anticoagulant drugs and short course glucocorticoids. Conclusions Children are generally susceptible to the Omicron strains, and vaccination helps to improve specific immunity. Therefore, strengthening isolation and vaccination are effective measures to prevent Omicron infection in children.

Key words: Omicron, clinical feature, vaccine, influencing factor, child

桂明珠, 刘英丽, 丁阿凤, 谢晓恬. 儿童新冠病毒Omicron株感染临床特征及其影响因素[J]. 临床儿科杂志, 2022, 40(10): 765-769.

GUI Mingzhu, LIU Yingli, DING Afeng, XIE Xiaotian. Clinical characteristics and influencing factors of SARS-CoV-2 Omicron variant infection in children[J]. Journal of Clinical Pediatrics, 2022, 40(10): 765-769.

图/表 3

表1

表2

表3

参考文献 17

[1]	World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard[EB/OL].(2021-03-18)[2021-03-18]. https://covid19.who.int/?gclid=Cj0KCQiA34OBBhCcARIsAG32uvP2GNKkSu8P5yxXT7Q3YnFzNKXq69jFTYfjWIvy4wFTiiuhDQI_2ucaAnM2EALw_wcB.
[2]	Shah M, Woo HG. Omicron: a heavily mutated SARS-CoV-2 variant exhibits stronger binding to ACE2 and potently escape approved COVID-19 therapeutic antibodies[J]. Front Immunol, 2022, 12: 830527. doi: 10.3389/fimmu.2021.830527
[3]	Li M, Lou F, Fan H. SARS-CoV-2 variant Omicron: currently the most complete "escapee" from neutralization by antibodies and vaccines[J]. Signal Transduct Target Ther, 2022, 7(1): 28.
[4]	American Academy of Pediatrics. Children and COVID-19: state-level data report[EB/OL].(2021-02-22)[2021-02-25]. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report.
[5]	世界卫生组织. 儿童和青少年的COVID-19疾病[EB/OL]. (2021-09-29) [2022-03-02]. https://apps.who.int/iris/bitstream/handle/10665/345575/WHO-2019-nCoV-Sci-Brief-Children-andadolescents-2021.1-chi.pdf.
[6]	焦富勇, 马蕾. 加强儿童奥密克戎感染的防治[J]. 中国当代儿科杂志, 2022, 24(4): 345-349.
[7]	傅晓燕, 桂明珠, 谢晓恬. 一家族三代聚集性新型冠状病毒感染诊治的归纳与思考[J]. 临床儿科杂志, 2020, 38(12): 908-911.
[8]	蒋荣猛, 谢正德, 姜毅, 等. 儿童新型冠状病毒感染诊断、治疗和预防专家共识 (第三版)[J]. 中华实用儿科临床杂志, 2021, 36(10): 721-732.
[9]	中国国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案(试行第九版)[J]. 国际流行病学传染病学杂志, 2022, 49(2): 73-80.
[10]	Jackson WM, Price JC, Eisler L, et al. COVID-19 in pediatric patients: a systematic review[J]. J Neurosurg Anesthesiol, 2022, 34(1): 141-147. doi: 10.1097/ANA.0000000000000803
[11]	Swann OV, Holden KA, Turtle L, et al. Clinical characteristics of children and young people admitted to hospital with covid-19 in United Kingdom: prospective multicentre observational cohort study[J]. BMJ, 2020, 370: m3249.
[12]	Aleem A, Akbar Samad AB, Slenker AK. Emerging variants of SARS-CoV-2 and novel therapeutics against coronavirus (COVID-19)[M]. Treasure Island (FL): StatPearls Publishing, 2022.
[13]	Diao B, Wang C, Tan Y, et al. Reduction and functional exhaustion of T cells in patients with coronavirus disease 2019 (COVID-19)[J]. Front Immunol, 2020, 11: 827. doi: 10.3389/fimmu.2020.00827 pmid: 32425950
[14]	Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents[J]. N Engl J Med, 2020, 383(4): 334-346. doi: 10.1056/NEJMoa2021680
[15]	Wu J, Deng W, Li S, et al. Advances in research on ACE2 as a receptor for 2019-nCoV[J]. Cell Mol Life Sci, 202, 78(2): 531-544.
[16]	中华人民共和国国家健康委员会, 国家中医药局. 儿童社区获得性肺炎诊疗规范(2019年版)[J]. 中华临床感染病杂志, 2019, 12(1): 6-13.
[17]	Saravolatz LD, Depcinski S, Sharma M. Molnupiravir and nirmatrelvir-ritonavir: oral COVID antiviral drugs[J]. Clin Infect Dis, 2022, 4: ciac180.

组别	例数	平均住院	发热人数	发热	最高体温	无症状+轻型	普通型+重型肺炎
组别	例数	天数	[n（%）]	天数	/℃	[n（%）]	[n（%）]
疫苗接种	33	6.2±3.1	14(42.4)	2.1±1.1	38.3±0.6	30（90.9）	3（9.1）
疫苗未接种	61	9.6±4.2	43(70.5)	2.3±1.4	39.1±0.8	42（68.9）	19（31.1）
统计量		t=2.302	t=7.068	t=1.453	t=2.227	χ²=4.646
P		0.026	0.008	0.152	0.030	0.013

型别	例数	HB/g·L^-1	WBC ×10⁹·L^-1	ANC ×10⁹·L^-1	ALC ×10⁹·L^-1	PLT ×10⁹·L^-1	CRP/ mg·L^-1
无症状+轻型	72	130.67±12.91	7.13±1.46	2.62±0.68	4.18±2.21	267.81±98.06	5.33±2.41
普通型+重型	22	128.35±12.82	6.32±2.56	2.56±1.50	2.66±1.93	247.28±79.18	6. 44±3.03
t值		0.174	0.586	0.008	5.486	0.611	1.846
P		0.678	0.447	0.930	0.024	0.438	0.180

组别	例数	阳性持续天数	ORF1ab基因C_t值	N基因C_t值
疫苗接种	33	10.27±2.31	30.01±4.40	28.03±5.91
疫苗未接种	61	12.05±4.13	26.88±5.19	23.54±6.68
t值		2.482	4.986	5.452
P		0.121	0.031	0.023