558例住院儿童人偏肺病毒肺炎临床特征分析

doi:10.12372/jcp.2023.22e0294

摘要/Abstract

摘要：

目的分析儿童人偏肺病毒肺炎（hMPV）的临床特征及重症发生的危险因素。方法回顾性分析2020年10月至2021年3月住院的hMPV肺炎患儿的临床资料。按病情分为轻症组及重症组进行比较分析。结果纳入hMPV肺炎558例，男309例、女249例，中位年龄3.4（1.7~4.4）岁，轻症组515例、重症组43例，合并基础病109例。与轻症组相比，重症组年龄<3岁以及有基础疾病史的患儿比例较高，差异有统计学意义（P<0.05）。hMPV肺炎患儿主要临床表现为发热（85.0%）、咳嗽（96.4%）、喘息（39.8%）及肺部湿啰音（74.0%），呕吐等肺外表现少见。113例合并细菌感染，其中以肺炎链球菌最常见（54例）。hMPV肺炎住院患儿的抗生素使用率较高（50.7%，283例）。重症组喘息、气促、喘鸣音、胸腔积液、肺不张，外周血白细胞计数、C反应蛋白水平，合并细菌感染比例均高于轻症组，差异有统计学意义（P<0.05）。与轻症组相比，重症组使用氧疗、肺泡灌洗、抗生素、全身糖皮质激素比例较高，住院时间较长，差异有统计学意义（P<0.05）。二分类logistic回归分析结果发现，年龄<3岁、喘息、合并基础病及CRP≥25 mg/L是发生重症hMPV肺炎的危险因素（P<0.05）。结论 hMPV肺炎主要以发热、咳嗽、喘息及肺部湿啰音为表现，易合并细菌感染，但肺外并发症少见，总体预后良好。但对于<3岁儿童，有喘息、合并基础病及C反应蛋白升高的患儿需警惕发生重症肺炎。

关键词: 人偏肺病毒, 肺炎, 住院, 儿童

Abstract:

Objective To analyze the clinical characteristics of human metapneumovirus (hMPV) pneumonia in children and the risk factors for severe hMPV pneumonia. Methods The clinical data of children with hMPV pneumonia hospitalized from October 2020 to March 2021 were retrospectively analyzed. The patients were divided into mild group and severe group for comparative analysis. Results A total of 558 patients (309 boys and 249 girls) with hMPV pneumonia were included, and the median age was 3.4 (1.7-4.4) years. There were 515 children in mild group and 43 in severe group. One hundred and nine children were complicated with underlying disease. Compared with the mild group, the severe group had a higher proportion of children younger than 3 years old and with a history of underlying diseases, and the difference was statistically significant (P<0.05). The main clinical manifestations of children with hMPV pneumonia were fever (85.0%), cough (96.4%), wheezing (39.8%) and pulmonary moist rales (74.0%). Extra-pulmonary manifestations such as vomiting were rare. One hundred and thirteen patients had bacterial infection, and Streptococcus pneumoniae was the commonest (54 cases). The rate of antibiotic use was higher in hospitalized children with hMPV pneumonia (50.7%, 283 cases). The proportion of wheezing, shortness of breath, wheezing sound, pleural effusion and atelectasis, the level of WBC and CRP in peripheral blood and the proportion of bacterial infection in the severe group were higher than those in the mild group, and the difference was statistically significant (P<0.05). Compared with the mild group, the proportion of oxygen therapy, alveolar lavage, antibiotics and systemic glucocorticoids use in the severe group was higher, the hospital stay was longer, and the difference was statistically significant (P<0.05). Binary logistic regression analysis showed that age <3 years old, wheezing, complicated underlying diseases and CRP≥25mg/L were risk factors for severe hMPV pneumonia (P<0.05). Conclusions The main manifestations of hMPV are fever, cough, wheezing and moist rale in the lungs which is easy to be complicated with bacterial infection, but extra-pulmonary complications are rare and the overall prognosis is good. However, for children < 3 years old, children with wheezing, underlying disease, and elevated CRP need to be alert to severe pneumonia.

Key words: human metapneumovirus, pneumonia, hospitalized, child

刘小兰, 罗小娟, 冯志冠, 刘春艳, 鲍燕敏, 郑跃杰. 558例住院儿童人偏肺病毒肺炎临床特征分析[J]. 临床儿科杂志, 2023, 41(6): 459-463.

LIU Xiaolan, LUO Xiaojuan, FENG Zhiguan, LIU Chunyan, BAO Yanmin, ZHENG Yuejie. Clinical analysis of 558 hospitalized children with human metapneumovirus pneumonia[J]. Journal of Clinical Pediatrics, 2023, 41(6): 459-463.

图/表 5

图1

表1

表2

表3

表4

参考文献 23

[1]	van den Hoogen BG, de Jong JC, Groen J, et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease[J]. Nat Med, 2001, 7: 719-724. doi: 10.1038/89098 pmid: 11385510
[2]	花盛浩, 邵雪君, 徐俊. 新型冠状病毒肺炎常态化防控下儿童常见呼吸道病毒感染谱的变化[J]. 中华传染病杂志, 2021, 39(10): 621-625.
[3]	Li L, Wang H, Liu A, et al. Comparison of 11 respiratory pathogens among hospitalized children before and during the COVID-19 epidemic in Shenzhen, China[J]. Virol J, 2021, 18: 202. doi: 10.1186/s12985-021-01669-y pmid: 34627307
[4]	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.
[5]	Sarkar S, Ratho RK, Singh M, et al. Comparative analysis of epidemiology, clinical features, and cytokine response of respiratory syncytial and human metapneumovirus infected children with acute lower respiratory infections[J]. Jpn J Infect Dis, 2022, 75(1): 56-62. doi: 10.7883/yoken.JJID.2021.151
[6]	Jongbloed M, Leijte WT, Linssen CFM, et al. Clinical impact of human metapneumovirus infections before and during the COVID-19 pandemic[J]. Infect Dis (Lond), 2021, 53: 488-497.
[7]	Liu WK, Chen DH, Tan WP, et al. Paramyxoviruses respiratory syncytial virus, parainfluenza virus, and human metapneumovirus infection in pediatric hospitalized patients and climate correlation in a subtropical region of southern China: a 7-year survey[J]. Eur J Clin Microbiol Infect Dis, 2019, 38: 2355-2364. doi: 10.1007/s10096-019-03693-x
[8]	Lim YK, Kweon OJ, Kim HR, et al. Clinical features, epidemiology, and climatic impact of genotype-specific human metapneumovirus infections: long-term surveillance of hospitalized patients in South Korea[J]. Clin Infect Dis, 2020, 70: 2683-2694. doi: 10.1093/cid/ciz697 pmid: 31353397
[9]	Zhu R, Guo C, Zhao L, et al. Epidemiological and genetic characteristics of human metapneumovirus in pediatric patients across six consecutive seasons in Beijing, China.[J]. Int J Infect Dis, 2020, 91: 137-142. doi: S1201-9712(19)30451-5 pmid: 31821893
[10]	胡倩, 郑跃杰, 王文建, 等. 儿童腺病毒肺炎541例临床特点分析[J]. 中华实用儿科临床杂志, 2021, 36(16): 1230-1234.
[11]	Howard LM, Edwards KM, Zhu Y, et al. Clinical features of human metapneumovirus-associated community-acquired pneumonia hospitalizations[J]. Clin Infect Dis, 2021, 72(1): 108-117. doi: 10.1093/cid/ciaa088 pmid: 32010955
[12]	Williams JV, Harris PA, Tollefson SJ et al. Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children[J]. N Engl J Med, 2004, 350(5): 443-450. doi: 10.1056/NEJMoa025472
[13]	Taniguchi A, Kawada JI, Go K, et al. Comparison of clinical characteristics of human metapneumovirus and respiratory syncytial virus infections in hospitalized young children[J]. Jpn J Infect Dis, 2019, 72: 237-242. doi: 10.7883/yoken.JJID.2018.480 pmid: 30814460
[14]	Marinari LA, Danny MA, Simpson SA, et al. Lower respiratory tract infection with human metapneumovirus: chest CT Imaging features and comparison with other viruses[J]. Eur J Radiol, 2020, 128: 108988.
[15]	顾文婧, 季伟, 张新星, 等. 混合感染因素对呼吸道偏肺病毒感染临床特征的影响[J]. 中华实用儿科临床杂志, 2017, 32(10): 730-734.
[16]	Evelyn O, Jaime FS, David M, et al. Prevalence, clinical outcomes and rainfall association of acute respiratory infection by human metapneumovirus in children in Bogotá, Colombia.[J]. BMC Pediatr, 2019, 19: 345. doi: 10.1186/s12887-019-1734-x pmid: 31601181
[17]	Schreiner D, Groendahl B, Puppe W, et al. High antibiotic prescription rates in hospitalized children with human metapneumovirus infection in comparison to RSV infection emphasize the value of point-of-care diagnostics[J]. Infection, 2019, 47: 201-207. doi: 10.1007/s15010-018-1194-5 pmid: 30132249
[18]	Driscoll AJ, Deloria Knoll M, Hammitt LL, et al. The effect of antibiotic exposure and specimen volume on the detection of bacterial pathogens in children with pneumonia[J]. Clin Infect Dis, 2017, 64: S368-S377. doi: 10.1093/cid/cix101
[19]	Papenburg J, Alghounaim M. Unraveling the pneumonia burden associated with human metapneumovirus infection[J]. Clin Infect Dis, 2021, 72: 118-120. doi: 10.1093/cid/ciz1249 pmid: 31900479
[20]	崔爱利, 谢智博, 余鹏博, 等. 2009年至2021年我国9省份发热呼吸道症候群病例中人偏肺病毒感染情况及流行特征分析[J]. 中华实用儿科临床杂志, 2021, 36(24): 1861-1865.
[21]	Kasundriya SK, Dhaneria M, Mathur A, et al. Incidence and risk factors for severe pneumonia in children hospitalized with pneumonia in Ujjain, India[J]. Int J Environ Res Public Health, 2020, 17: 13. doi: 10.3390/ijerph17010013
[22]	Shan W, Shi T, Chen K, et al. Risk factors for severe community-aquired pneumonia among children hospitalized with CAP younger than 5 years of age[J]. Pediatr Infect Dis J, 2019, 38: 224-229. doi: 10.1097/INF.0000000000002098 pmid: 29746377
[23]	Cherchi C, Chiarini Testa MB, Deriu D, et al. All you need is evidence: what we know about pneumonia in children with neuromuscular diseases[J]. Front Pediatr, 2021, 9: 625751.

项目	轻症组(n=515)	重症组(n=43)	统计量	P
男性[n(%)]	287(55.7)	22(51.2)	χ²=0.34	0.563
年龄<3岁[n(%)]	193(37.5)	25(58.1)	χ²=7.12	0.008
基础病史[n(%)]	90(17.5)	19(44.2)	χ²=18.01	<0.001
过敏史[n(%)]	99(19.2)	7(16.3)	χ²=4.46	0.035
临床特征
发热[n(%)]	435(84.5)	39(90.7)	χ²=1.21	0.272
热程[M(P₂₅~P₇₅)]/d	4.0(2.0~5.0)	4.0(2.0~5.0)	Z=0.52	0.600
咳嗽[n(%)]	497(96.5)	41(95.3)	χ²=0.00	1.000
喘息[n(%)]	195(37.9)	27(62.8)	χ²=10.29	0.001
气促[n(%)]	64(12.4)	33(76.7)	χ²=114.31	<0.001
喘鸣音[n(%)]	213(41.4)	35(81.4)	χ²=25.76	<0.001
湿啰音[n(%)]	378(73.4)	35(81.4)	χ²=1.32	0.251
胸腔积液[n(%)]	0(0.0)	3(7.0)	-	<0.001¹⁾
肺不张[n(%)]	0(0.0)	21(48.8)	χ²=248.04	<0.001
呼吸衰竭[n(%)]	0(0.0)	9(20.9)	-	<0.001¹⁾

组别	例数	WBC[M(P₂₅~P₇₅)]/×10⁹·L^-1	CRP[M(P₂₅~P₇₅)]/mg·L^-1	PCT[M(P₂₅~P₇₅)]/ng·mL^-1	细菌感染[n(%)]
轻症组	515	8.2(6.1~11.6)	5.8(1.9~17.5)	0.8(0.1~0.7)	97(18.8)
重症组	43	9.6(6.7~14.7)	25.7(9.1~52.4)	0.6(0.2~1.8)	16(37.2)
统计量		Z=2.02	Z=4.90	Z=1.98	χ²=8.30
P		0.044	<0.001	0.050	0.004

组别	例数	氧疗[n(%)]	肺泡灌洗[n(%)]	抗生素[n(%)]	全身糖皮质激素[n(%)]	住院天数[M(P₂₅~P₇₅)]/d
轻症组	515	5(1.0)	14(2.7)	245(47.6)	15(2.9)	4.0(3.0~6.0)
重症组	43	17(39.5)	13(30.2)	38(88.4）	8(18.6)	7.0(6.0~9.0)
统计量		χ²=155.84	χ²=65.25	χ²=25.82	χ²=24.73	Z=6.77
P		<0.001	<0.001	<0.001	<0.001	<0.001

危险因素	偏回归系数	标准误	χ²值	P	OR(95%CI)
年龄<3岁	0.77	0.35	4.86	0.028	2.17(1.09~4.30)
喘息	0.96	0.36	7.36	0.007	2.61(1.31~5.21)
合并基础病	1.34	0.35	14.59	<0.001	3.81(1.92~7.58)
CRP≥25 mg·L^-1	1.61	0.34	21.79	<0.001	5.02(2.55~9.88)
常量	4.28	0.40	115.40	<0.001	0.014