摘要
目的 分析婴儿呼吸道合胞病毒（RSV）相关急性下呼吸道感染（ALRI）的临床流行病学特点,探讨RSV感染的危险因素.方法 采用描述性回顾性临床流行病学调查方法,调查2011年3月1日至2012年2月29日复旦大学附属儿科医院内科（含新生儿科）收治的1 726例确诊为ALRI且年龄≤1岁患儿的临床流行病学资料,分析RSV感染的季节分布、人口学特征、家庭特征、基础疾病情况.并采用Logistic多元回归分析RSV感染的危险因素.结果 1 726例ALRI患儿中,RSV感染患儿913例（52.9％）,全年均有发生,冬季检出率最高（59.1％）.RSV阳性组患儿中位年龄（P25～ P75）为64（21～155）d,胎龄（37.5±2.4）周,出生体重（3.07 ±0.66） kg,男女比例为1.9：1.RSV阳性组患儿家庭环境拥挤、被动吸烟、母亲特应性疾病史及孕期糖尿病的发生率均高于RSV阴性组（P均＜0.05）.RSV感染患儿伴发基础疾病者542例,显著高于RSV阴性患儿（59.4％vs.54.2％,P＜0.05）.单因素Logistic分析显示,早产儿（OR=1.346,95％ CI：1.037 ～1.748）、低出生体重儿（OR=1.447,95％ CI：1.103 ～1.898）、有基础疾病史（OR=1.232,95％ CI：1.018 ～ 1.492）、先天性心脏病史（OR=1.391,95％ CI：1.120 ～1.728）、吸烟环境（OR=1.254,95％ CI：1.035～1.519）、母亲特应性疾病史（OR=1.827,95％ CI：1.296～2.573）、家庭居住人口≥4人（OR=1.232,95％ CI：1.013～1.498）、秋冬两季发病（秋季：OR=1.351,95％CI：1.024～1.783;冬季：OR=1.713,95％CI：1.332 ～2.204）为RSV感染的危险因素.多因素Logistic回归分析：先天性心脏病（OR=1.298,95％CI：1.002～1.681）、母亲特应性疾病史（OR=1.766,95％ CI：1.237 ～2.520）、秋冬两季发病（秋OR=1.481,95％ CI：1.105 ～1.985;冬OR=1.766,95％ CI：1.358 ～2.296）是RSV感染的独立危险因素.结论 RSV感染在冬季检出率最高,早产儿、低出生体重儿发病率高,患有先天性心脏病、母亲有特应性疾病史及秋冬季节发病的患儿RSV感染的风险大为增加.
Objective To investigate the clinical epidemiologic characteristics and analyze risk factors for acute respiratory syncytial virus （RSV） infection in hospitalized infants with acute lower respiratory tract infection （ALRI）.Method ALRI infants admitted to Children＇s Hospital of Fudan University from March 1 st,2011 to February 29th,2012,were enrolled in this study.Patient information included demographic characteristics,feeding history,family status,clinical presentation,accessory examination,treatment and prognosis.According to the etiology of ALRI infants,we compared the seasonal distribution,demographic characteristics,household characteristics and underlying diseases between RSV-positive patients and RSV-negative patients.Univariate and multiple Logistic regression analyses were used to determine factors that were associated with risk of RSV infection.Result Among 1 726 ALRI infants,there were 913 RSV-positive infants （52.9％）.The occurrence of RSV infection had a seasonal variation,with a peak in winter （59.1％）.The median （P25,P75） age of RSV infants was 64 （21-155） days.The gestational age （GA） and body weight （BW） was （37.5 ± 2.4） weeks and （3.07 ±0.66） kg,respectively.The male/female ratio among these was 1.9：1.RSV infection was more popular among infants in the families with smoking members,crowded living conditions,history of atopic mother.Differences of the proportion of patients with underlying disease between RSV-positive and negative groups were statistically significant （59.4％ vs.54.2％,P ＜ 0.05）.Univariate logistic regression demonstrated that factors increasing the risk of RSV infection were：GA ＜ 37weeks （OR =1.346,95％ CI：1.037-1.748）,birth weight ＜ 2 500 g （OR =1.447,95 ％ CI：1.103-1.898）,underlying diseases （OR =1.232,95 ％ CI：1.018-1.492）,underlying CHD （OR =1.391,95％ CI：1.120-1.728）,environmental tobacco smoke exposure （OR =1.254,95％ CI：1.035-1.519）,mother with atopic diseases （OR =1.827,95％ CI：1.296-2.573）,crowded house with four or more than four family members （OR =1.232,95％ CI：1.013-1.498）,autumn or winter infection （OR =1.351,95％ CI：1.024-1.783 ; OR =1.713,95％ CI：1.332-2.204）.Multivariate logistic regression determined the factors increasing the risk of RSV infection were：underlying CHD （OR =1.298,95％ CI：1.002-1.681）,mother with atopic diseases （OR =1.766,95％ CI：1.237-2.520）,autumn or winter infection （OR =1.481,95％ CI：1.105-1.985 ; OR =1.766,95％ CI：1.358-2.296）.Conclusion The prevalence of RSV infection was the highest in winter,while preterm and low birth weight infants were more susceptible.Underlying diseases were found in 59.4％ cases,CHD was the most common one.The factors increasing the risk of RSV infection were：CHD,mother with atopic diseases,autumn or winter infections.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2014年第5期373-377,共5页
Chinese Journal of Pediatrics
基金
上海市卫生计生委基金（20134249）
上海市科委医学引导项目（134119a4200）
关键词
呼吸道合胞病毒
呼吸道感染
危险因素
Respiratory syncytial virus
Respiratory tract infections
Risk factors
作者简介
通信作者：钱莉玲（Email：llqian@126．com）
