2015-2017年上海市儿童医院重症社区获得性肺炎比例与流行特点
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摘要
目的了解上海市儿童医院2015-2017年社区获得性肺炎(以下简称肺炎)住院患儿中的重症肺炎比例及其分布和变化特点,为防治儿童重症肺炎、降低死亡率提供参考。方法在该院已结构化的2015-2017年电子病案数据库中按诊断标准纳入肺炎住院对象15 041例并筛查其中的重症患儿,获取住院病史的一般人口学信息,分析肺炎重症比例及人口学分布的特点,使用logistic回归检验分布差异的统计学意义,计算关联强度OR值。结果该院肺炎总的重症比例为13. 5%(2 028/15 041),2016年相对较低(11. 3%),不同年份表现出不同的季节特点,多因素分析显示夏、秋、冬三季的重症比例均高于春季(13. 6%、13. 1%、14. 6%vs. 12. 2%),无论单因素或多因素分析均显示:年龄1～岁、4～岁的肺炎重症比例均高于0～岁(14. 2%、22. 9%vs. 7. 9%),户籍地外省相对本市的重症比例较高(15. 2%vs. 12. 5%),中等以上营养风险相对无营养风险的重症比例较高(25. 7%vs. 12. 2%),上述差异均有统计学意义(P<0. 01)。结论重症肺炎具有一定的季节规律,且与年龄、户籍地、营养情况较为相关,增加了经济负担,同时也增加了潜在的死亡风险,值得引起关注,可采取改善营养、接种肺炎球菌疫苗、注意空气污染、防治上呼吸道感染等措施以期降低重症肺炎比例。
Objective To investigate the proportion,distribution and changing characteristics of severe community-acquired pneumonia( hereinafter referred to as pneumonia) among hospitalized children in Shanghai Children's Hospital in 2015-2017,and to provide evidence for prevention and treatment of pediatric severe pneumonia and decline of mortality. Methods We acquired general demographic information of pediatric severe pneumonia inpatients among 15,041 pneumonia inpatients who were diagnosed according to the diagnostic criteria and selected from the structured electronic medical record database during the years2015-2017 in Shanghai Children's Hospital. The proportion of severe pneumonia cases and the demographic distribution features were analyzed. Logistic regression was used to test the statistical significance of distribution differences,and the odd ratio was calculated. Results The proportion of total cases of severe pneumonia in this hospital was 13.5%( 2,028/15,041). The proportion of severe pneumonia cases was found to be relatively lower in 2016( 11.3%),and showed different seasonal characteristics in different years. Multivariate regression analysis showed that the proportions of severe pneumonia cases in summer( 13.6%),autumn( 13.1%) and winter( 14.6%) were all higher than that in spring( 12.2%). Univariate and multivariate regression analyses indicated that the proportion of severe pneumonia cases was higher in inpatients aged 1-year( 14.2%) and 4-years( 22.9%)than in ones aged 0-year( 7.9%),higher in inpatients from other provinces( 15.2%) than in local ones( 12.5%),and higher in inpatients at middle or above risk of malnutrition( 25.7%) than in ones without risk of malnutrition( 12.2%),showing statistically significant differences( all P<0.01) Conclusions Severe pneumonia had a certain seasonal dynamic regularity; moreover,it is correlated with age,place of household registration and nutrition status. Severe pneumonia may increase economic burden and possible mortality,which should be noticed. Feasible countermeasures,including nutrition improvement,receiving pneumococcal vaccine,paying attention to air pollution,and preventing and treating upper respiratory tract infection can be adopted to decrease the proportion of severe pneumonia.
Objective To investigate the proportion,distribution and changing characteristics of severe community-acquired pneumonia( hereinafter referred to as pneumonia) among hospitalized children in Shanghai Children's Hospital in 2015-2017,and to provide evidence for prevention and treatment of pediatric severe pneumonia and decline of mortality. Methods We acquired general demographic information of pediatric severe pneumonia inpatients among 15,041 pneumonia inpatients who were diagnosed according to the diagnostic criteria and selected from the structured electronic medical record database during the years2015-2017 in Shanghai Children's Hospital. The proportion of severe pneumonia cases and the demographic distribution features were analyzed. Logistic regression was used to test the statistical significance of distribution differences,and the odd ratio was calculated. Results The proportion of total cases of severe pneumonia in this hospital was 13.5%( 2,028/15,041). The proportion of severe pneumonia cases was found to be relatively lower in 2016( 11.3%),and showed different seasonal characteristics in different years. Multivariate regression analysis showed that the proportions of severe pneumonia cases in summer( 13.6%),autumn( 13.1%) and winter( 14.6%) were all higher than that in spring( 12.2%). Univariate and multivariate regression analyses indicated that the proportion of severe pneumonia cases was higher in inpatients aged 1-year( 14.2%) and 4-years( 22.9%)than in ones aged 0-year( 7.9%),higher in inpatients from other provinces( 15.2%) than in local ones( 12.5%),and higher in inpatients at middle or above risk of malnutrition( 25.7%) than in ones without risk of malnutrition( 12.2%),showing statistically significant differences( all P<0.01) Conclusions Severe pneumonia had a certain seasonal dynamic regularity; moreover,it is correlated with age,place of household registration and nutrition status. Severe pneumonia may increase economic burden and possible mortality,which should be noticed. Feasible countermeasures,including nutrition improvement,receiving pneumococcal vaccine,paying attention to air pollution,and preventing and treating upper respiratory tract infection can be adopted to decrease the proportion of severe pneumonia.
引文
[1]王卫平.儿科学[M].北京:人民卫生出版社,2015:277-278.
[2]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南2013修订版[S].中华儿科杂志,2013,51(11):856-862.
[3]郭晓辉,孙艳峰,王江波,等.营养风险筛查对重症肺炎儿童不良临床结局的评估[J].中国当代儿科杂志,2017,19(3):322-326.
[4]Jain S,Williams DJ,Arnold SR,et al. Community-acquired pneumo-nia requiring hospitalization among U. S. children[J]. N Engl J Med,2015,372(9):835-845.
[5]Ngari MM,Fegan G,Mwangome MK,et al. Mortality after inpatienttreatment for severe pneumonia in children:a cohort study[J]. Paedi-atr Perinat Epidemiol,2017,31(3):233-242.
[6]靳淑雁,刘世新,郑静,等. 2012-2014年深圳市5岁以下儿童肺炎流行特征与病原学分析[J].实用预防医学,2016,23(6):701-704.
[7]陈霞,刘文恩,蒋红梅,等. 1 691例呼吸道感染患者病原学流行病学调查[J].实用预防医学,2018,25(8):975-977.
[8]欧阳飞云,刘四云,冒洁,等.大气污染与长沙市某儿童医院肺炎住院人数的关联性[J].中南大学学报(医学版),2017,42(12):1417-1424.
[9]中华预防医学会和中华预防医学会疫苗与免疫分会.肺炎球菌性疾病免疫预防专家共识(2017版)[S].中国预防医学杂志,2018,19(3):161-189.
[10]Sempertegui F,Estrella B,Rodriguez O,et al. Zinc as an adjunct tothe treatment of severe pneumonia in Ecuadorian children:a random-ized controlled trial[J]. Am J Clin Nutr,2014,99(3):497-505.
[11]Moschovis PP,Banajeh S,Mac Leod WB,et al. Childhood anemia athigh altitude:risk factors for poor outcomes in severe pneumonia[J].Pediatrics,2013,132(5):1156-1162.
[12]谢朝云,熊芸,覃家露,等.儿童细菌性重症肺炎多重耐药菌感染相关因素分析[J].中国儿童保健杂志,2018,26(3):326-329.
[2]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南2013修订版[S].中华儿科杂志,2013,51(11):856-862.
[3]郭晓辉,孙艳峰,王江波,等.营养风险筛查对重症肺炎儿童不良临床结局的评估[J].中国当代儿科杂志,2017,19(3):322-326.
[4]Jain S,Williams DJ,Arnold SR,et al. Community-acquired pneumo-nia requiring hospitalization among U. S. children[J]. N Engl J Med,2015,372(9):835-845.
[5]Ngari MM,Fegan G,Mwangome MK,et al. Mortality after inpatienttreatment for severe pneumonia in children:a cohort study[J]. Paedi-atr Perinat Epidemiol,2017,31(3):233-242.
[6]靳淑雁,刘世新,郑静,等. 2012-2014年深圳市5岁以下儿童肺炎流行特征与病原学分析[J].实用预防医学,2016,23(6):701-704.
[7]陈霞,刘文恩,蒋红梅,等. 1 691例呼吸道感染患者病原学流行病学调查[J].实用预防医学,2018,25(8):975-977.
[8]欧阳飞云,刘四云,冒洁,等.大气污染与长沙市某儿童医院肺炎住院人数的关联性[J].中南大学学报(医学版),2017,42(12):1417-1424.
[9]中华预防医学会和中华预防医学会疫苗与免疫分会.肺炎球菌性疾病免疫预防专家共识(2017版)[S].中国预防医学杂志,2018,19(3):161-189.
[10]Sempertegui F,Estrella B,Rodriguez O,et al. Zinc as an adjunct tothe treatment of severe pneumonia in Ecuadorian children:a random-ized controlled trial[J]. Am J Clin Nutr,2014,99(3):497-505.
[11]Moschovis PP,Banajeh S,Mac Leod WB,et al. Childhood anemia athigh altitude:risk factors for poor outcomes in severe pneumonia[J].Pediatrics,2013,132(5):1156-1162.
[12]谢朝云,熊芸,覃家露,等.儿童细菌性重症肺炎多重耐药菌感染相关因素分析[J].中国儿童保健杂志,2018,26(3):326-329.