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中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (3): 200-203.

• 论著 • 上一篇    下一篇

济南市单中心迁延性咳嗽患儿中百日咳的横断面调查

韩玉玲1,4，杨春2,4，丁明杰1，程璐1，孙静1，林美函3，马香1   

  1. 1 山东大学齐鲁儿童医院呼吸科 济南，250022；2 山东大学齐鲁儿童医院医学检验中心 济南，250022；3 山东省泰山医学院 泰安，271016；4 共同第一作者
  • 收稿日期:2016-04-25 修回日期:2016-06-25 出版日期:2016-06-25 发布日期:2016-06-25
  • 通讯作者: 马香

The cross-sectional study on the prevalence of pertussis in children with protracted cough in a single center in Jinan

HAN Yu-ling1,4, YANG Chun2,4, DING Ming-jie1, CHENG Lu1, SUN Jing1, LIN Mei-han3, MA Xiang1   

  1. 1 Department of Respiratory, Jinan Children′s Hospital, Jinan 250022; 2 Department of Laboratory,Jinan Children′s Hospital, Jinan 250022; 3 Taishan Medical University, Taian 271016, China;4 Co-first author
  • Received:2016-04-25 Revised:2016-06-25 Online:2016-06-25 Published:2016-06-25
  • Contact: MA Xiang

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摘要：

目的 调查济南地区2015年百日咳在迁延性咳嗽患儿中的流行情况，提高临床医生对百日咳的认识。方法 纳入2015年1月1日至12月31日在山东大学齐鲁儿童医院呼吸科门诊就诊的迁延性咳嗽患儿，行百日咳血清抗体及PCR检测，分析百日咳患儿的年龄、疫苗接种情况、季节分布、临床特点和预后等。结果 3 068例迁延性咳嗽患儿中，符合百日咳临床诊断657例（21.4%），其中百日咳血清抗体和（或）PCR诊断545例（83.0%）。0～3月龄247/1 093例（22.6%），～1岁199/1 055例（18.9%），～7岁168/846例（19.8%），～14岁43/74例（58.1%），~14岁患儿的诊断率显著高于其他年龄段患儿。百日咳和非百日咳病例完全疫苗接种率～1岁分别为45.7％（91/199）和72.7％（622/856），～7岁分别为73.2％（123/168）和97.0％（658/678），百日咳和非百日咳病例间差异均有统计学意义；～14岁百日咳和非百日咳病例完全疫苗接种率相近（41/43 vs 29/31）。百日咳PCR检测阳性545例，同时血清抗体阳性372例。百日咳病例数从5月份开始升高，7~9月份维持高水平，10~12月份逐渐下降。29例0～3月龄百日咳患儿家庭成员有临床症状，其中9例及其家长同时血清抗体或PCR检测阳性，6例血清抗体或PCR检测阳性家长其孩子符合百日咳临床诊断。657例临床诊断百日咳患儿中，215例（32.7%）伴喘息，298例（45.4%）伴发热。114/657例住院治疗，6例（0.9%）死亡，死亡原因为百日咳脑病3例、窒息1例、心力衰竭1例、不能脱离呼吸机1例。结论 2015年济南地区迁延性咳嗽患儿中百日咳诊断率高，尤其是7~14岁儿童，且有一定的季节流行趋势，将疫苗接种提前及加强学龄前复种有助于百日咳防控。

Abstract:

Objective To investigate the epidemiology of pertussis in the children with protracted cough in Jinan.Methods Outpatients and inpatients with protracted cough visiting the Department of Respiratory of Jinan Children′s Hospital from January 1 to December 31 2015 were recruited to receive pertussis serum antibody and PCR detection. Information about the age of pertussis diagnosis, vaccination, season, clinical characteristics and prognosis was analyzed.Results Of 3 068 suspected cases with pertussis, 657 (21.4%) cases were clinically diagnosed as pertussis, of them, 545 (83.0%) cases were diagnosed by pertussis serum antibody and/or PCR. 247 (22.6%) cases aged from 0 to 3 months, 199 (18.9%) aged from 3 months to 1 year, 168 (19.8%) aged from 1 to 7 years, 43 (58.1%) aged from 7 to 14 years. The diagnostic rate in children aged from 7 to 14 years was significantly higher than other children. The vaccination rate in children aged from 3 months to 1 year with pertussis or non-pertussis was 45.7% (91/199) and 73.7% (622/856), and the vaccination rate was 73.2% (123/168) and 97.0% (658/678) in children aged from 1 to 7 years. The vaccination rates between children aged from 7 to 14 years with pertussis and non-pertussis were similar (41/43 vs 29/31). PCR testing was positive in 545 cases (17.8%), of them, 372 cases (12.1%) with positive serum antibody. The number of pertussis cases increased from May, with high level from July to September and decreased from October to December. Twenty-nine persons in the pertussis children family had clinical symptoms, of them 9 cases and their parents both with positive serum antibody or PCR results, 6 children were clinically diagnosed with negative but whose parents with positive serum antibody or PCR results. Of 657 children with clinical diagnosis, 215 (32.7%) had breathing, 298 (45.4%) with fever. Six cases died from pertussis encepholopathy (3 cases), asphyxia (1 case), heart failure (1 case), persisting mechanical ventilation (1 case, gave up treatment).Conclusion Pertussis accounted for a large proportion of the children under 14 years with protracted cough in Jinan, especially in the children aged from 7 to 14 years. Pertussis showed a certain seasonal trend in Jinan. To protect the prevalence of pertussis, some measures should be taken including early vaccination 2 months after birth and revaccination for the preschool children.

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