RSV感染及非RSV感染毛细支气管炎的临床特征及严重度对比分析

摘要

目的 探讨呼吸道合胞病毒(respiratory syncytial virus,RSV)感染及非RSV感染毛细支气管炎的临床特征及病情严重度特点.方法 选取2012年11月至2014年3月毛细支气管炎住院患儿96例.采用直接免疫荧光法检测RSV抗原,根据检测结果分成RSV感染组和非RSV感染组,对比两组患儿人口学资料、过敏状况等临床特征.两组用改良Tal评分法进行临床评分,并分析临床评分与发病天数及住院天数的相关性以评价病情严重度.结果 共筛选入组毛细支气管炎患儿96例,RSV感染组为40例(41.67％).与非RSV感染的毛细支气管炎患儿相比,RSV感染者住院年龄小(t=-2.706,P=0.008),体重低(t=-2.070,P=0.041),而性别比例、出生方式、出生体重、身长等差异均无统计学意义(P＞0.05).两组患儿湿疹史、过敏性家族史及血清总IgE差异无统计学意义(P＞0.05).从病情严重程度对比来看,RSV感染组临床评分显著高于非RSV感染者(t=-0.405,P＜0.001),住院时间有延长趋势(t=0.480,P=0.081).临床评分与住院天数呈正相关(r=0.305,P=0.003),与发病天数无显著相关性(P＞0.05).结论 RSV感染的毛支气管炎患儿年龄偏小,体重偏低,临床评分较高提示病情较重.毛细支气管炎的临床评分与住院天数呈正相关.结合病原学检查及改良的Tal评分系统,可有助于早期识别重症毛细支气管炎患儿,早期给予严密观察和及时有效的治疗.%Objective To investigate the differences of clinical characteristics and disease severity between respiratory syncytial virus (RSV) and non-RSV bronchiolitis.Methods Ninety-six bronchiolitis inpatients of Shengjing Hospital from November 2012 to March 2014 were enrolled.RSV detection was performed at enrollment by direct immunofluorescence assay and the patients were divided into RSV group and non-RSV group.Clinical characteristics were collected and compared, including patients' demographic data, allergy, etc.Clinical scores were assessed by modified-Tal score system, and the associations between clinical scores and duration of onset or length of stay were analyzed to assess disease severity.Results In all 96 patients, forty (46.17％) were determined to be infected with RSV.Patients with RSV bronchiolitis were younger at hospitalization (t =-2.706,P =0.008) and the weight was lower (t =-2.070, P =0.041).There was no significant differences in sex, birth way, birth weight, height, ete (P ＞ 0.05).There was no significant differences in eczema, history of family allergy and total serum IgE (P ＞ 0.05).For patients with RSV bronchiolitis, the clinical scores were higher (t =-0.405 ,P ＜0.001) and the length of stay trended to be longer (t =0.480 ,P =0.081).The clinical score had a positive relation with length of stay (r =0.305, P =0.003), but not with the duration of onset (P ＞ 0.05).Conclusion Compared with non-RSV bronchiolitis, the clinical characteristics of patients with RSV bronchiolitis are younger age and lower weight, and have higher clinical scores, which indicates the clinical conditions may be more severe.For bronchiolitis, there is a positive correlation between clinical score and length of stay.The combination of etiological detection and modified-Tal score system may help to recognize severe cases, which should be observed carefully and treated immediately.