708例百日咳住院患儿临床特征及合并重症肺炎危险因素分析

doi:10.12372/jcp.2026.25e0910

Abstract

Abstract:

Objective To analyze the clinical characteristics of pertussis in children and explore the independent risk factors for pertussis complicated by ordinary pneumonia and severe pneumonia. Methods A retrospective cohort study was conducted on the clinical data of 708 children hospitalized with pertussis in our hospital from August 2021 to June 2024. Patients were divided into three groups: pertussis without pneumonia (n=306), pertussis with ordinary pneumonia (n=316), and pertussis with severe pneumonia (n=86). Baseline clinical characteristics and laboratory indicators upon admission were compared. Multinomial logistic regression analysis (with the non-pneumonia group as the reference) was used to identify independent factors associated with ordinary and severe pneumonia. Results Among the 708 children, 400 were male (56.5%) and 308 were female (43.5%), with a median age of 4 months (1 month - 4 years), infants≤3 months accounted for 46.3%. The co-infection rate was 68.50%, with rhinovirus being the most common. Significant differences were found among the three groups in age, fever, underlying diseases, DTP vaccination status, WBC count, LYM% and Bordetella pertussis cycle threshold (BP-C_t) values (P<0.05). Post-hoc comparisons showed significant differences in these indicators for the severe pneumonia group compared to the other two groups, whereas no significant differences were observed between the ordinary pneumonia and non-pneumonia groups. Multinomial logistic regression analysis showed no statistically significant independent predictors for distinguishing ordinary pneumonia from non-pneumonia (P>0.05). However, for severe pneumonia, fever (OR=10.601, 95%CI: 5.235-21.466), underlying diseases (OR=5.576, 95%CI: 2.651-11.726), low BP-C_t value (high bacterial load) (OR=5.174, 95%CI: 1.911-14.005), and WBC>30×10⁹/L (OR=3.371, 95%CI: 1.520-7.474) were identified as independent risk factors. Conclusion Pneumonia is a common complication in hospitalized children with pertussis. While ordinary pneumonia is clinically difficult to distinguish from uncomplicated pertussis in the early stages, fever, underlying diseases, high bacterial load (low BP-C_t), and hyperleukocytosis serve as early warning indicators for the progression to severe pneumonia.

Key words: pertussis, pneumonia, severe pertussis pneumonia, risk factors, child

CLC Number:

HUANG Tao, CAO Ke, FU Xiaoying, CHEN Yunsheng, LUO Xiaojuan. Clinical features and severe pneumonia risk factors in 708 pediatric pertussis inpatients[J].Journal of Clinical Pediatrics, 2026, 44(4): 283-290.

Figures/Tables 4

Figure 1

Table 1

Table 2

Table 3

References 28

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混合感染病原	百日咳未合并肺炎组 (n=306)	百日咳合并普通肺炎组 (n=316)	百日咳合并重症肺炎组 (n=86)
病毒感染
鼻病毒	90	128	29
呼吸道合胞病毒	22	27	15
副流感病毒	21	22	7
腺病毒	21	21	5
偏肺病毒	9	21	1
甲型流感病毒	8	11	0
冠状病毒	12	9	2
乙流病毒	5	6	2
博卡病毒	2	3	1
肺炎衣原体	0	1	0
肺炎支原体	11	25	7
细菌感染
流感嗜血杆菌	7	10	7
肺炎链球菌	3	4	4
肺炎克雷伯菌	0	2	1
金黄色葡萄球菌	0	0	1
大肠埃希菌	1	0	2
鲍曼不动杆菌	0	0	1
铜绿假单胞菌	0	0	1
耶氏肺孢子菌	0	0	2

变量	百日咳未合并肺炎组（n=306）	百日咳合并普通肺炎组（n=316）	百日咳合并重症肺炎组（n=86）	统计量	P
男[n(%)]	168(54.90)	184(58.23)	48(55.81)	0.72	0.698
月龄[M(P₂₅~P₇₅)]/月	4.00(2.50~14.25)^a	4(2.70~14.00)^a	3(1.76~9.75)^b	9.65	0.008
月龄≤3月[n(%)]	144(47.06)^a,b	133(42.09)^b	51(59.30)^a	8.17	0.017
入院前病程[M(P₂₅~P₇₅)]/天	14(10~20)^a	15(10~20)^a	13(8~20)^b	1.20	0.549
接触史[n(%)]	158(51.63)	165(52.21)	52(60.47)	2.55	0.280
多孩家庭[n(%)]	161(52.61)	149(47.15)	44(51.16)	5.42	0.066
早产[n(%)]	16(5.23)	21(6.65)	9(11.63)	4.66	0.097
未接种DTP[n(%)]	147(48.04)^a	145(45.89)^a	57(66.28)^b	11.59	0.003
基础病史[n(%)]	27(8.82)^a	32(10.12)^a	32(37.21)^b	52.08	<0.001
发热[n(%)]	94(30.71%)^a	117(37.03%)^a	64(74.42%)^b	54.76	<0.001
WBC[M(P₂₅~P₇₅)]/10⁹·L^-1	15.16(10.48~21.81)^a	15.04(10.55~22.66)^a	23.10(17.07~33.87)^b	25.83	<0.001
WBC>30×10⁹/L[n(%)]	22(7.19)^a	32(10.13)^a	28(32.56)^b	41.96	<0.001
LYM[M(P₂₅~P₇₅)]/%	66.67(51.42~73.87)^a	65.71(50.30~72.97)^a	57.13(45.84~67.49)^b	10.39	0.006
BP-C_t[M(P₂₅~P₇₅)]	27.53(23.94~31.56)^a	26.94(24.00~1.00)^a	24.29(21.51~28.35)^b	14.11	0.001

比较组别与变量	B	SE	χ²值	P	OR(95%CI)
普通肺炎组与未合并肺炎组
LYM%	0.291	0.289	1.012	0.314	1.338(0.759~2.359)
月龄≤3月	0.023	0.243	0.009	0.924	1.023(0.636~1.648)
发热	0.339	0.2	2.865	0.091	1.404(0.948~2.08)
基础疾病	0.154	0.303	0.257	0.612	1.166(0.644~2.111)
WBC>30×10⁹/L	0.435	0.316	1.897	0.168	1.545（0.832~2.868）
未接种DTP疫苗	-0.154	0.244	0.396	0.529	0.858（0.531~1.384）
BP-C_t低	-0.472	0.444	1.131	0.287	0.624(0.261~1.489)
重症肺炎组与未合并肺炎组
LYM%	0.327	0.363	0.812	0.367	1.386(0.681~2.822)
月龄≤3月	0.431	0.425	1.027	0.311	1.538(0.669~3.539)
发热	2.361	0.36	43.017	<0.001	10.601(5.235~21.466）
基础疾病	1.718	0.379	20.528	<0.001	5.576（2.651~11.726）
WBC>30×10⁹/L	1.215	0.406	8.948	0.003	3.371(1.52~7.474)
未接种DTP疫苗	0.458	0.451	1.035	0.309	1.582(0.654~3.826)
BP-C_t低	1.644	0.508	10.465	0.001	5.174(1.911~14.005)

Clinical features and severe pneumonia risk factors in 708 pediatric pertussis inpatients

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