CAJ | 학술논문

目的探讨麻疹患儿死亡危险因素,为儿童麻疹的死亡风险评估提供依据.方法回顾性分析2009年11月至2010年6月河北省儿童医院住院治疗的麻疹患儿临床资料,根据预后不同,将患儿分为痊愈组和死亡组.收集患儿人口学特征和临床资料,采用单因素分析,对有统计学意义的因素进行共线性诊断,共线性诊断后的因素纳入多因素条件Logistic回归分析模型,采用逐步前进法,以选人P≤0.05,剔除P≥0.10的变量为检验水准,探讨麻疹患儿死亡危险因素.结果研究期间共纳入932例麻疹患儿,其中16例死亡,住院患儿病死率为1.72％.16例死亡患儿中,男9例,女7例,年龄6～44个月,15例居住在农村；14例未接种或未规范接种麻疹疫苗,11例存在多种基础疾病,分别为呼吸系统疾病5例、先天性心脏病1例、神经系统疾病2例和营养不良2例,以及1例患儿为先天性心脏病合并呼吸系统疾病；16例患儿均合并肺炎,15例合并气胸、纵隔气肿、呼吸衰竭、急性呼吸窘迫综合征等严重呼吸道并发症.单因素回归分析表明,预后的危险因素有年龄＞8个月(OR ＝2.751,P＝0.007)、患有基础疾病(OR＝32.961,P＝0.000)、肺炎OR=11.911,P=0.017)、发热(OR＝29.844,P=0.000)、WBC升高(OR=4.816,P＝ 0.000)、Hb降低(OR=2.135,P＝0.017)、ALT升高(OR＝2.672,P＝0.006)、合并严重呼吸道并发症(OR=82.818,P=0.000).多因素回归分析结果显示,合并基础疾病(OR＝ 35.390,P＝0.000)、WBC升高(OR=19.370,P=0.000)、有严重呼吸道并发症(OR=13.696,P＝0.016)是影响预后的危险因素.结论患有基础疾病、WBC升高、有严重呼吸道并发症是麻疹患儿死亡的独立危险因素.
목적 탐토마진환인사망위험인소,위인동마진적사망풍험평고제공의거.방법 회고성분석2009년11월지2010년6월하북성인동의원주원치료적마진환인림상자료,근거예후불동,장환인분위전유조화사망조.수집환인인구학특정화림상자료,채용단인소분석,대유통계학의의적인소진행공선성진단,공선성진단후적인소납입다인소조건Logistic회귀분석모형,채용축보전진법,이선인P≤0.05,척제P≥0.10적변량위검험수준,탐토마진환인사망위험인소.결과 연구기간공납입932례마진환인,기중16례사망,주원환인병사솔위1.72％.16례사망환인중,남9례,녀7례,년령6～44개월,15례거주재농촌；14례미접충혹미규범접충마진역묘,11례존재다충기출질병,분별위호흡계통질병5례、선천성심장병1례、신경계통질병2례화영양불량2례,이급1례환인위선천성심장병합병호흡계통질병；16례환인균합병폐염,15례합병기흉、종격기종、호흡쇠갈、급성호흡군박종합정등엄중호흡도병발증.단인소회귀분석표명,예후적위험인소유년령＞8개월(OR ＝2.751,P＝0.007)、환유기출질병(OR＝32.961,P＝0.000)、폐염OR=11.911,P=0.017)、발열(OR＝29.844,P=0.000)、WBC승고(OR=4.816,P＝ 0.000)、Hb강저(OR=2.135,P＝0.017)、ALT승고(OR＝2.672,P＝0.006)、합병엄중호흡도병발증(OR=82.818,P=0.000).다인소회귀분석결과현시,합병기출질병(OR＝ 35.390,P＝0.000)、WBC승고(OR=19.370,P=0.000)、유엄중호흡도병발증(OR=13.696,P＝0.016)시영향예후적위험인소.결론 환유기출질병、WBC승고、유엄중호흡도병발증시마진환인사망적독립위험인소.
Objective To explore the risk factors related to mortality in subjects with measles,and to provide reference for death risk assessment in measles affected children.Methods A retrospective study was conducted among patients with measles who were hospitalized in Hebei Children's Hospital from November 2009 to June 2010.Patients were classified into cure group and death group according to disease outcomes.Demographic and clinical data were collected and compared by univariate analysis.Collinearity diagnostics were performed among variates with statistical significance,which were further analyzed by multivariate Logistic regression analysis to explore risk factors for death in children with measles.Results A total of 932 patients were included,among which 16 (1.72％) were fatal.Among the death cases that aged 6 to 44 months,9 were males; 15 cases lived in rural areas; 14 cases had irregular implementation of measles vaccination; 11 cases had underlying diseases,including respiratory diseases in 5 cases,congenital heart disease in 1 cases,neurological disorder in 2 cases,malnutrition in 2 cases,and congenital heart disease with respiratory disease in 1 case.All the death cases were complicated by pneumonia,and 15 of them developed serious respiratory complications including pneumothorax,mediastinal emphysema,respiratory failure and acute respiratory distress syndrome (ARDS).In univariate analysis,elder than 8 months (OR=2.751,P=0.007),underlying diseases (OR=32.961,P＝0.000),pneumonia (OR=11.911,P=0.017),hyperpyrexia (OR=29.844,P=0.000),elevation of peripheral blood leucocytes (OR =4.816,P=0.000) and alanine transaminase (OR=2.672,P=0.006),decreased hemoglobin (OR=2.135,P=0.017) and serious respiratory complications (OR=82.818,P=0.000) were identified as risk factors of poor prognosis.Multivariate Logistic regression analysis showed that death was significantly associated with underlying diseases (OR=35.390,P =0.000),elevation of peripheral blood leucocytes (OR=19.370,P=0.000) and serious respiratory complications (OR=13.696,P=0.016).Conclusion Underlying diseases,elevation of peripheral blood leucocytes and serious respiratory complications are identified as independent risk factors for death in measles affected children.