【摘要】 目的 探讨甲型流感病毒感染患儿的临床特征及发生重症的危险因素，为临床早期识别重症患儿提供指导。方法 选取2018年12月-2020年12月西安市儿童医院和西安市中心医院收治住院的368例甲型流感病毒感染患儿，根据病情严重程度分为轻症组（237例）和重症组（131例）。统计分析一般资料及实验室检查结果，多因素logistic回归分析各相关因素与重症甲型流感患儿的相关性。结果 368例甲型流感患儿中，237例（64.4%）为轻症，131例（35.6%）为重症。重症组患儿发热持续时间、病程中出现气喘及呕吐症状、合并基础疾病明显高于轻症组，差异均有统计学意义（Z/χ~2=-3.958、5.104、4.958、8.814,P均<0.05）。重症组白细胞计数（WBC）、中性粒细胞计数、中性粒细胞与淋巴细胞比值（NLR）、降钙素原（PCT）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）、肌酸激酶同工酶（CK-MB）均高于轻症组，淋巴细胞计数低于轻症组，差异均有统计学意义（Z=-3.110、-5.501、-4.006、-6.153、-2.815、-3.911、-3.067、-2.022,P均<0.05）。重症组混合感染率高于轻症组，细菌检出率高于轻症组，差异均有统计学意义（χ~2=4.081、6.034,P均<0.05）。受试者工作特征曲线分析NLR预测重症甲型流感的最佳临界值为1.46，曲线下面积为0.738。多因素logistic回归分析显示，发热持续时间（OR=3.257,P<0.001）、NLR(OR=3.577,P<0.001)、合并基础疾病（OR=1.386,P=0.004）均为重症甲型流感发生的独立危险因素。结论 发热持续时间延长、NLR升高、合并基础疾病的甲型流感患儿更易进展为重症病例。更多还原

【Abstract】 Objective To explore the clinical characteristics and risk factors of severe cases in children with influenza A virus infection,and provide guidance for early identification of severe cases. Methods A total of 368 children with influenza A virus infection admitted to the Xi’an Children’s Hospital and the Xi’an Central Hospital from December 2018 to December 2020 were divided into mild influenza A group(237 cases)and severe influenza A group(131 cases)according to the severity of the disease. The clinical characteristics and laboratory examinations were statistical analyzed;multivariate logistic regression analysis were used to analyze the correlations between the factors and the severity of children with influenza A. Results Among the 368 children with influenza A,237 cases(64.4%)were mild and 131 cases(35.6%)were severe. The duration of fever,symptoms of asthma and vomiting,and complicated underlying diseases in the severe influenza A group were significantly higher than those in the mild influenza A group(Z/χ~2=-3.958,5.104,4.958,8.814,all P<0.05). The white blood cell count(WBC),neutrophil count,neutrophil-to-lymphocyte ratio(NLR),procalcitonin(PCT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatine kinase isoenzyme(CK-MB)in severe influenza A group were higher than those in the mild influenza A group,while the lymphocyte count was lower than that in the mild influenza A group;the differences were statistically significant(Z=-3.110,-5.501,-4.006,-6.153,-2.815,-3.911,-3.067,-2.022,all P<0.05). The mixed infection rate in the severe influenza A group was higher than that in the mild group,and the bacterial detection rate was higher than that in the mild group,with statistical significance（χ~2=4.081,6.034,all P<0.05）. The optimal cut-off value of the receiver operating characteristic curve for NLR to predict severe influenza A was 1.46,and the area under the curve was 0.738. Multivariate logistic regression analysis showed that fever duration(OR=3.257,P<0.001),NLR(OR=3.577,P<0.001)and combined underlying diseases(OR=1.386,P=0.004)were independent risk factors for severe influenza A. Conclusion Children with influenza A with prolonged fever duration,elevated NLR,and combined underlying diseases were more likely to develop severe cases.更多还原