儿童甲型H1N1流行性感冒相关性脑病死亡危险因素分析

doi:10.12372/jcp.2025.24e0881

摘要/Abstract

摘要：

目的寻找儿童甲型H1N1流行性感冒（简称流感）相关性脑病（IAE）死亡的危险因素，为临床早期诊断及干预提供依据。方法回顾性分析2014年1月至2020年12月医院收治的甲型H1N1 IAE患儿的临床资料，按预后分为存活组与死亡组。通过二分类logistic回归分析与甲型H1N1 IAE患儿死亡相关的危险因素。结果共纳入甲型H1N1 IAE 59例患儿，男39例、女20例，中位年龄为42（21~73）个月，<5岁患儿占66.1%（39/59）。出现神经系统症状与发热相距时间中位数为1（0.5~2）天。33例（55.9%）患儿并发重症肺炎、呼吸衰竭，其中1例并发塑型性支气管炎。58例患儿使用奥司他韦抗流感治疗，发病至使用抗流感药物中位时间为2（1~4）天。好转出院48例，死亡11例（18.6%），入院至死亡中位时间为3（1~5）天。与存活组相比，死亡组意识障碍、呼吸衰竭、脑疝发生率以及需要机械通气治疗的比例更高，中性粒细胞计数更高，降钙素原、血糖、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、乳酸脱氢酶水平更高，凝血酶原时间更长，头颅CT异常比例更高，单核细胞计数更低，差异均有统计学意义（P<0.05）。二分类logistic回归分析结果发现，中性粒细胞计数以及乳酸脱氢酶水平升高可能与甲型H1N1 IAE患儿死亡发生相关（P<0.05）。结论对于甲型H1N1 IAE患儿，如中性粒细胞计数和乳酸脱氢酶水平升高时，发生死亡的风险可能增加，需引起重视。

关键词: 甲型H1N1流感, 脑病, 死亡, 危险因素, 儿童

Abstract:

Objective To explore the risk factors of death from influenza A (H1N1)-associated encephalopathy (IAE) in children, and to provide evidence for early clinical diagnosis and intervention. Methods The clinical data of children with H1N1 IAE admitted to the hospital from January 2014 to December 2020 were retrospectively analyzed, and they were divided into the survival group and the death group according to prognosis. The risk factors associated with death in children with H1N1 IAE were analyzed by binary logistic regression. Results A total of 59 children (39 boys and 20 girls) with H1N1 IAE were included. The median age was 42 (21-73) months, and 66.1% (39/59) of the children were <5 years old. The median time between the onset of neurological symptoms and fever was 1 (0.5-2) days. Thirty-three patients (55.9%) had severe pneumonia and respiratory failure, and 1 of them had plastic bronchitis. Fifty-eight children were treated with oseltamivir. The median time from onset to use of anti-influenza drugs was 2 (1-4) days. Forty-eight patients were discharged from hospital with improvement and 11 died (18.6%). The median time from admission to death was 3 (1-5) days. Compared with the survival group, the death group presented higher incidences of consciousness disorder, respiratory failure, and brain herniation, a greater proportion of cases requiring mechanical ventilation treatment, a higher neutrophil count, elevated levels of procalcitonin, blood glucose, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase, a longer prothrombin time, a higher ratio of abnormal head CT findings, and a lower monocyte count. All the differences were statistically significant (P<0.05). The results of binary logistic regression analysis revealed that elevated neutrophil count and lactate dehydrogenase levels might be associated with the occurrence of death in children with H1N1 IAE (P<0.05). Conclusions For children with H1N1 IAE, the risk of death may increase with elevated neutrophil counts and lactate dehydrogenase levels.

Key words: influenza A (H1N1), encephalopathy, death, risk factor, child

李珊珊, 胡丹丹. 儿童甲型H1N1流行性感冒相关性脑病死亡危险因素分析[J]. 临床儿科杂志, 2025, 43(3): 177-183.

LI Shanshan, HU Dandan. Analysis of risk factors for death from influenza A (H1N1)-associated encephalopathy in children[J]. Journal of Clinical Pediatrics, 2025, 43(3): 177-183.

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项目	存活组(n=48)	死亡组(n=11)	统计量	P
男性[n(%)]	34(70.8)	5(45.5)	χ²=1.56	0.211
年龄( x±s)/月	46.2±32.5	62.7±29.1	t=1.36	0.180
热峰( x±s)/℃	39.8±0.8	39.9±0.7	t=0.73	0.466
热程[M(P₂₅~P₇₅)]/d	5.0(4.0~7.5)	3.0(1.8~6.0)	Z=1.85	0.064
季节[n(%)]			－	0.328¹⁾
冬春	41(85.4)	11(100.0)
夏秋	7(14.6)	0(0.0)
发病前接种流感疫苗²⁾	13(28.9)	4(36.4)	χ²=0.01	0.906
癫痫发作[n(%)]	32(66.8)	9(81.8)	－	0.534¹⁾
意识障碍[n(%)]	30(62.5)	11(100)	－	0.038¹⁾
呼吸衰竭[n(%)]	22(45.8)	11(100)	－	0.003¹⁾
电解质紊乱[n(%)]	5(10.4)	1(9.1)	χ²=0.00	1.000
脑疝[n(%)]	0(0)	10(90.9)	－	<0.001¹⁾
神经系统症状距发热时间[M(P₂₅~P₇₅)]/d	1.0(0.5~2.0)	0.3(0~2.0)	Z=1.30	0.194
治疗[n(%)]
奥司他韦	48(100.0)	10(90.9)	－	0.186¹⁾
激素	24(50.0)	7(63.6)	χ²=0.67	0.414
丙种球蛋白	29(60.4)	6(54.4)	χ²=0.00	0.986
激素联合丙种球蛋白	19(39.6)	4(36.4)	χ²=0.00	1.000
机械通气	12(25.0)	11(100.0)	－	<0.001¹⁾
降颅压	33(68.8)	7(63.6)	χ²=0.00	1.000
发病至使用奥司他韦时间[M(P₂₅~P₇₅)]/d	2.0(1.0~3.8)	1.5(1.0~4.5)	Z=0.27	0.785

项目	存活组(n=48)	死亡组(n=11)	统计量	P
血液检查
WBC( x±s)/×10⁹·L^-1	9.9±5.2	11.2±4.4	t=1.75	0.086
PLT( x±s)/×10⁹·L^-1	243.6±92.4	195.1±106.5	t=1.31	0.195
中性粒细胞计数[M(P₂₅~P₇₅)]/×10⁹·L^-1	6.8(2.0~11.1)	10.2(5.5~13.5)	Z=2.17	0.030
淋巴细胞计数[M(P₂₅~P₇₅)]/×10⁹·L^-1	1.4(0.6~3.3)	0.9(0.6~3.1)	Z=0.58	0.953
单核细胞计数[M(P₂₅~P₇₅)]/×10⁹·L^-1	0.4(0.2~0.8)	0.2(0.2~0.4)	Z=2.34	0.019
HB[M(P₂₅~P₇₅)]/g·L^-1	117.0(111.0~122.0)	111.0(103.0~121.3)	Z=0.81	0.419
超敏CRP[M(P₂₅~P₇₅)]/mg·L^-1	2.4(1.0~18.4)	11.4(1.2~18.4)	Z=0.25	0.800
PCT[M(P₂₅~P₇₅)]/ng·mL^-1	0.6(0.1~5.1)	8.6(1.6~26.0)	Z=2.58	0.010
血糖[M(P₂₅~P₇₅)]/mmol·L^-1	6.2(5.3~7.8)	8.5(5.8~12.6)	Z=2.01	0.045
乳酸[M(P₂₅~P₇₅)]/mmol·L^-1	1.5(1.1~2.3)	1.7(1.4~4.0)	Z=1.76	0.079
血氨[M(P₂₅~P₇₅)]/μmol·L^-1	46.6(21.8~78.6)	51.3(28.9~72.3)	Z=0.48	0.633
AST[M(P₂₅~P₇₅)]/U·L^-1	43.0(35.0~105.0)	144.5(43.3~537.0)	Z=2.63	0.009
ALT[M(P₂₅~P₇₅)]/U·L^-1	16.0(13.0~38.0)	55.50(17.8~176.3)	Z=2.57	0.010
LDH[M(P₂₅~P₇₅)]/U·L^-1	396.0(291.5~731.5)	626.5(453.3~1 706.5)	Z=2.96	0.003
CK[M(P₂₅~P₇₅)]/U·L^-1	171.0(69.8~486.3)	167.0(90.1~679.5)	Z=0.69	0.488
APTT[M(P₂₅~P₇₅)]/s	34.7(30.3~41.2)	35.9(28.7~45.5)	Z=0.53	0.599
PT[M(P₂₅~P₇₅)]/s	13.2(12.4~15.1)	14.7(12.7~18.2)	Z=2.13	0.034
脑脊液检查¹⁾[n(%)]
白细胞升高	2(5.4)	1(25.0)	－	0.271⁴⁾
脑脊液蛋白阳性	5(13.5)	1(25.0)	－	0.483⁴⁾
潘氏蛋白阳性	3(8.1)	2(50.0)	－	0.066⁴⁾
头颅CT异常²⁾[n(%)]	7(18.4)	8(80.0)	χ²=11.25	<0.001
头颅MRI异常³⁾[n(%)]	20(50.0)	1(100.0)	－	1.000⁴⁾

项目	偏回归系数	标准误	χ²值	P	OR(95%CI)
中性粒细胞计数	0.174	0.085	4.26	0.039	1.190(1.009~1.405)
LDH	0.002	0.001	6.80	0.009	1.002(1.001~1.004)