新生儿肠道病毒感染并发出血-坏死性肝炎回顾性巢式病例对照研究

doi:10.3969/j.issn.1673-5501.2021.02.002

摘要/Abstract

摘要： 背景出血-坏死性肝炎(HNC)是新生儿肠道病毒感染的严重并发症之一,早期识别困难,病情进展迅速,病死率高。目的分析新生儿肠道病毒感染并发HNC的临床特点,为早期识别和积极治疗HNC提供依据。设计回顾性巢式病例对照研究。方法纳入2010年1月至2020年1月复旦大学附属儿科医院收治的新生儿肠道病毒感染患儿,收集患儿的临床特征、治疗及预后,比较HNC组和无HNC组病例的临床特点及HNC发生的危险因素。主要结局指标 HNC发生率、病死率和危险因素。结果共纳入108例新生儿肠道病毒感染,HNC组32例(29.6%),无HNC组76例。HNC组出生胎龄、出生体重、起病日龄均低于无HNC组(P＜0.05)。HNC组孕母有可疑感染史比例高于无HNC组(P＜0.001)。HNC组病死率高于无HNC组(46.9% vs 2.6%,P＜0.001)。多因素Logistic回归分析显示,孕母可疑感染史(OR=7.04,95%CI:2.20~22.55)及起病日龄(OR=0.903,95%CI:0.819~0.996)是HNC独立影响因素。HNC死亡亚组AST峰值和INR峰值均高于存活亚组(P分别为0.016和0.009)。HNC死亡亚组合并心肌炎比例高于存活亚组(P=0.008)。死亡亚组血浆、白蛋白、机械通气及血管活性药物使用率增高。17例HNC存活患儿中,11例完成随访,均未报告听力障碍、失明、癫痫、脑瘫、智力低下等远期不良预后。结论新生儿肠道病毒感染患儿中HNC的发生率较高。孕母可疑感染史和患儿起病日龄小与发生HNC显著相关;HNC患儿病死率高,尤其是严重肝损伤、并发心肌炎者,但存活者预后良好。

关键词: 肠道病毒感染, 临床特征, 坏死性肝炎, 新生儿, 预后

Abstract: Background Hepatic necrosis with coagulopathy (HNC) is one of the serious complications of neonatal enterovirus infection. Early recognition is difficult, the disease progresses rapidly, and the mortality rate is high.Objective To study the clinical features of neonatal enterovirus infections with HNC, and to provide a basis for early identification and active treatment of HNC.DesignA retrospective nested case-control study.Methods The neonates with enterovirus infection admitted to Children's Hospital of Fudan University from January 2010 to January 2020 were included. The clinical characteristics, treatment and prognosis were collected, and the clinical characteristics of the HNC group and the non-HNC group were compared,as well as the risk factors for the occurrence of HNC.Main outcome measures Incidence,mortality and risk factors of HNC.Results A total of 108 cases of neonatal enterovirus infections were included with 32 cases (29.6%) in the HNC group and 76 cases in the non-HNC group. The gestational age, birth weight, and age of onset of the HNC group were significantly lower than those of the non-HNC group (P＜0.05). The maternal history of illness in the HNC group was significantly higher than that in the non-HNC group (P＜0.001). The mortality of neonates in the HNC group was significantly higher than that of the non-HNC group (46.9% vs 2.6%, P＜0.001). Multivariate logistic regression analysis showed that the maternal history of illness (OR=7.04, 95%CI: 2.20-22.55) and age of onset (OR=0.903, 95%CI: 0.819-0.996) were independently associated with HNC. The peak AST level in the HNC death subgroup was significantly higher than that in the survival subgroup(P=0.016). The peak INR level in the HNC death subgroup was significantly higher than that in the survival subgroup(P=0.009). The proportion of complicated myocarditis in the HNC death subgroup was significantly higher than that in the survival subgroup (P=0.008). The use rate of plasma, albumin, mechanical ventilation and vasoactive drugs in the HNC death subgroup increased significantly.Among the 17 surviving children with HNC, 11 were followed up without a poor long-term prognosis such as dysaudia, blindness, epilepsy cerebral palsy and mental retardation.Conclusion In neonates with enterovirus infection, the incidence of HNC is higher. The maternal history of illness and earlier age of onset are significantly related to HNC. The mortality rate of neonates with HNC is high, especially those with severe hepatic necrosis and concurrent myocarditis, but the survival group usually has a good prognosis.

Key words: Enterovirus infection, Clinical feature, Hepatic necrosis, Neonate, Prognosis

林晴晴, 蒋思远, 吴永芳, 庄德义, 曹云. 新生儿肠道病毒感染并发出血-坏死性肝炎回顾性巢式病例对照研究[J]. 中国循证儿科杂志, 2021, 16(2): 88-92.

LIN Qingqing, JIANG Siyuan, WU Yongfang, ZHUANG Deyi, CAO Yun. Neonatal enterovirus infections with hepatic necrosis with coagulopathy:A retrospective nested case-control study[J]. Chinese Journal of Evidence-Based Pediatrics, 2021, 16(2): 88-92.

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