切换至 "中华医学电子期刊资源库"
高级检索
中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2022, Vol. 18 ›› Issue (06) : 669 -676. doi: 10.3877/cma.j.issn.1673-5250.2022.06.008

论著

影响Omicron变异株感染轻型和普通型COVID-19患儿核酸转阴时间缩短因素分析
秦凤1, 丁博1, 陈轶维2, 周建国3, 张婷4, 俞蕙5, 王立波6, 周文浩3, 卢燕鸣1,†()   
  1. 1上海交通大学医学院附属仁济医院儿科，上海　201124
    2国家儿童医学中心/上海交通大学医学院附属上海儿童医学中心心内科，上海　200127
    3国家儿童医学中心/复旦大学附属儿科医院新生儿科，上海　201102
    4上海市儿童医院/上海交通大学医学院附属儿童医院消化科，上海　200062
    5国家儿童医学中心/复旦大学附属儿科医院感染传染科，上海　201102
    6国家儿童医学中心/复旦大学附属儿科医院呼吸科，上海　201102
  • 收稿日期:2022-08-17 修回日期:2022-10-23 出版日期:2022-12-01
  • 通信作者: 卢燕鸣

Analysis of influencing factors of shortened time of viral nucleic acid negative conversion in mild and common COVID-19 children infected with Omicron variant strain

Feng Qin1, Bo Ding1, Yiwei Chen2, Jianguo Zhou3, Ting Zhang4, Hui Yu5, Libo Wang6, Wenhao Zhou3, Yanming Lu1,†()   

  1. 1Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201124, China
    2Department of Cardiology, National Children′s Medical Center/Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
    3Department of Neonatology, National Children′s Medical Center/Children′s Hospital of Fudan University, Shanghai 201102, China
    4Department of Gastroenterology, Children′s Hospital of Shanghai, Children′s Hospital Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
    5Department of Infectious Diseases, National Children′s Medical Center/Children′s Hospital of Fudan University, Shanghai 201102, China
    6Department of Respiratory, National Children′s Medical Center/Children′s Hospital of Fudan University, Shanghai 201102, China
  • Received:2022-08-17 Revised:2022-10-23 Published:2022-12-01
  • Corresponding author: Yanming Lu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

秦凤, 丁博, 陈轶维, 周建国, 张婷, 俞蕙, 王立波, 周文浩, 卢燕鸣. 影响Omicron变异株感染轻型和普通型COVID-19患儿核酸转阴时间缩短因素分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2022, 18(06): 669-676.

Feng Qin, Bo Ding, Yiwei Chen, Jianguo Zhou, Ting Zhang, Hui Yu, Libo Wang, Wenhao Zhou, Yanming Lu. Analysis of influencing factors of shortened time of viral nucleic acid negative conversion in mild and common COVID-19 children infected with Omicron variant strain[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(06): 669-676.

目的

探讨Omicron变异株感染轻型与普通型新型冠状病毒疾病(COVID-19)患儿的临床特征及影响其核酸检测结果转为阴性(以下简称为"核酸转阴")时间缩短因素。

方法

选取2022年4月7日至5月20日上海交通大学医学院附属仁济医院南院区"亲子病房"集中收治的150例Omicron变异株感染轻型和普通型COVID-19患儿为研究对象。采用回顾性分析方法，根据这150例患儿的核酸转阴中位时间为13 d，将其分别纳入快转阴组(n＝84，核酸转阴时间<13 d)和慢转阴组(n＝66，核酸转阴时间≥13 d)。对2组患儿年龄、性别、轻型与普通型COVID-19患儿构成比、疫苗接种率、COVID-19相关临床表现及COVID-19发病48 h内系统炎症指数(SII)、中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、血小板与淋巴细胞比值(PLR)等，进行成组t检验、Mann-Whitney U检验或χ2检验。采用多因素非条件logistic回归分析方法，分析影响Omicron变异株感染轻型与普通型COVID-19患儿核酸转阴时间缩短的因素。2组患儿合并基础疾病占比、采取对症治疗率等一般临床资料分别比较，差异均无统计学意义(P>0.05)。本研究遵循的程序符合2013修订的《世界医学协会赫尔辛基宣言》要求。

结果

①快转阴组患儿年龄、女性患儿比例、普通型COVID-19患儿比例、疫苗接种率，发热、咽痛、胃肠道症状发生率，均显著高于慢转阴组，而热峰、肌肉酸痛发生率，则均显著低于慢转阴组，2组比较，差异均有统计学意义(P<0.05)。②多因素非条件logistic回归分析结果显示，伴有咽痛、接种疫苗是轻型与普通型COVID-19患儿核酸转阴时间缩短的独立保护因素(OR＝14.609、7.866，95%CI：1.108~192.697、1.313~47.121，P＝0.042、0.024)，而伴有肌肉酸痛、男性患儿则是其独立危险因素(OR＝0.275、0.206，95%CI：0.087~0.874、0.083~0.511，P＝0.029、0.001)。③快转阴组患儿SII为250.9×109/L(111.1×109/L，466.9×109/L)，NLR为1.0(0.6，2.2)，均分别显著高于慢转阴组的109.8×109/L(47.2×109/L，266.7×109/L)与0.5(0.2，1.2)，并且差异均有统计学意义(Z＝6.48、5.34，P＝0.011、0.021)。快转阴组患儿LMR为4.1(2.5，9.4)，显著低于慢转阴组的8.2(3.4，11.1)，并且差异有统计学意义(Z＝4.50，P＝0.034)。

结论

轻型与普通型COVID-19患儿临床表现不典型，以发热、咳嗽为主，高SII、NLR及低LMR患儿核酸转阴时间较短，接种疫苗、伴有咽痛是促进核酸转阴时间缩短的保护性因素，伴有肌肉酸痛及男性是影响核酸转阴时间缩短的危险因素。

关键词: 严重急性呼吸综合征冠状病毒2, 新型冠状病毒疾病, 疫苗接种, Omicron株, 病毒，核酸转阴, 外周血参数比值, 儿童
Objective

To investigate the clinical features of mild and common corona virus disease 2019 (COVID-19) children infected with Omicron variant, and influencing factor of shortened time of nucleic acid negative conversion.

Methods

A total of 150 mild and common COVID-19 children infected with Omicron variant in the " parent-child ward" of the southern area of Renji Hospital, School of Medicine, Shanghai Jiao Tong University from April 7 to May 20, 2022 were selected as research subjects. According to the median time of nucleic acid negative conversion (13 d), these 150 children were included in fast turning negative group (n=84, time of nucleic acid negative conversion <13 d) and slow turning negative group (n=66, time of nucleic acid negative conversion ≥13 d). Independent-samples t test, Mann-Whitney U test or chi-square test were performed for comparison between two groups, such as age, gender, composition ratio of mild and common COVID-19, vaccination rate, clinical manifestations related to COVID-19, and systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR) within 48 h of COVID-19 onset. Analysis of influencing factors of shortened time of nucleic acid negative conversion in mild and common COVID-19 children infected with Omicron variant was conducted by multivariate unconditional logistic regression analysis. There was no statistically significant difference between two groups in the proportion of children with basic diseases and the rate of symptomatic treatment (P>0.05). The procedures followed in this study were in accordance with the Helsinki Declaration of the World Medical Association revised in 2013.

Results

①The age, proportion of female children, proportion of children with common type of COVID-19, vaccination rate, incidence of fever, sore throat and gastrointestinal symptoms in fast turning negative group were significantly higher than those in slow turning negative group, while the heat peak and incidence of muscle soreness were significantly lower than those in slow turning negative group, and all the differences were statistically significant (P<0.05). ②Multivariate unconditional logistic regression analysis showed that sore throat and vaccination were independent protective factors for shortened time of nucleic acid negative conversion of mild and common COVID-19 children (OR=14.609, 7.866; 95%CI: 1.108-192.697, 1.313-47.121; P=0.042, 0.024), while with muscle pain and male children were its independent risk factors (OR=0.275, 0.206; 95%CI: 0.087-0.874, 0.083-0.511; P=0.029, 0.001). ③The SII of children in fast turning negative group was 250.9×109/L (111.1×109/L, 466.9×109/L), NLR was 1.0 (0.6, 2.2), which both were significantly higher than 109.8×109/L (47.2×109/L, 266.7×109/L) and 0.5 (0.2, 1.2) respectively in slowly turning negative group, and the differences were statistically significant (Z=6.48, 5.34; P=0.011, 0.021). The LMR in fast negative group was 4.1 (2.5, 9.4), which was significantly lower than that 8.2 (3.4, 11.1) of slow negative group, and the difference was statistically significant (Z=4.50, P=0.034).

Conclusions

The symptoms of children with mild and common COVID-19 are not typical, mainly with fever and cough. Children with high SII, NLR, and low LMR have a shorter time of nucleic acid negative conversion of Omicron variant. Vaccination with vaccine, and accompanied by sore throat are protective factors to promote the nucleic acid negative conversion of Omicron variant. While muscle soreness and boys are relative risk factors affecting the time of nucleic acid negative conversion of Omicron variant.

Key words: SARS-CoV-2, COVID-19, Vaccination, Omicron variant, Viral, nucleic acid negative conversion, Peripheral blood parameter ratios, Child
表1 2组轻型与普通型COVID-19患儿临床表现及接种疫苗情况比较
组别 例数 年龄[岁，M(Q1，Q3)] 性别[例数(%)] COVID-19类型[例数(%)] 接种疫苗[例数(%)] 基础疾病[例数(%)]
男 女 轻型 普通型
快转阴组 84 4.2(1.9，7.6) 41(48.8) 43(51.2) 58(69.0) 26(31.0) 32(38.1) 6(7.1)
慢转阴组 66 1.5(0.5，3.4) 43(65.2) 23(34.8) 64(96.9) 2(3.1) 3(4.5) 5(7.6)
统计量 Z＝－5.03 χ2＝4.01 χ2＝18.98 χ2＝23.26 χ2＝0.01
P值 <0.001 0.045 <0.001 <0.001 0.920
组别 例数 发热[例数(%)] 热峰(℃，±s) 咳嗽[例数(%)] 咽痛[例数(%)] 胃肠道症状[例数(%)] 肌肉酸痛[例数(%)] 纳差[例数(%)]
快转阴组 84 76(90.5) 38.7±0.9 36(42.9) 12(14.3) 21(25.0) 10(11.9) 23(27.4)
慢转阴组 66 57(86.4) 39.0±0.9 32(48.4) 3(4.8) 7(10.6) 18(27.3) 19(28.8)
统计量 χ2＝0.62 t＝5.70 χ2＝0.47 χ2＝3.90 χ2＝5.04 χ2＝5.75 χ2＝0.04
P值 0.430 0.017 0.492 0.048 0.025 0.017 0.850
表2 影响轻型与普通型COVID-19患儿核酸转阴时间缩短因素的多因素非条件logistic回归分析结果
影响因素 B SE Wald值 P值 OR值 OR值95%CI
发热 0.656 1.045 0.394 0.530 1.927 0.248~14.945
咳嗽 －0.478 0.423 1.280 0.258 0.620 0.271~1.420
咽痛 2.682 1.316 4.152 0.042 14.609 1.108~192.697
胃肠道症状 －0.876 0.894 0.961 0.327 0.416 0.072~2.401
肌肉酸痛 －1.290 0.589 4.790 0.029 0.275 0.087~0.874
纳差 1.006 0.515 3.814 0.051 2.733 0.996~7.498
接种疫苗 2.062 0.913 5.099 0.024 7.866 1.313~47.121
年龄 －0.194 0.146 1.747 0.186 0.824 0.618~1.098
热峰 0.735 0.394 3.483 0.062 2.085 0.964~4.510
男性患儿 －1.579 0.463 11.612 0.001 0.206 0.083~0.511
轻型COVID-19 －1.721 1.305 1.739 0.187 0.179 0.014~2.309
常数项 －30.611 17.917 2.919 0.088 0 —
表3 2组轻型与普通型COVID-19患儿SII、NLR、LMR、PLR比较[M(Q1，Q3)]
组别 例数a SII(×109/L) NLR LMR PLR
快转阴组 40 250.9(111.1，466.9) 1.0(0.6，2.2) 4.1(2.5，9.4) 92.6(59.4，145.8)
慢转阴组 50 109.8(47.2，266.7) 0.5(0.2，1.2) 8.2(3.4，11.1) 68.8(48.2，95.3)
Z值 6.48 5.34 4.50 2.88
P值 0.011 0.021 0.034 0.090
[1]
World Health Organization. Coronavirus disease (COVID-19) weekly epidemiological update and weekly operational update[EB/OL]. (2022-04-20)[2022-04-21].

URL    
[2]
World Health Organization. Classification of Omicron (B.1.1.529): SARS-CoV-2 variant of concern[EB/OL]. (2021-11-26)[2022-04-22].

URL    
[3]
Seyit M, Avci E, Nar R, et al. Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19[J]. Am J Emerg Med, 2021, 40: 110-114. DOI: 10.1016/j.ajem.2020.11.058.
[4]
殷荣，陆权，焦佳丽. 等. 儿童新型冠状病毒Omicron变异株感染病毒核酸转阴特点及其影响因素[J]. 中华儿科杂志，2022, 60(12): 1307-1311. DOI: 10.3760/cma.j.cn112140-20220623-00582.
[5]
Islamoglu MS, Borku-Uysal B, Yavuzer S, et al. The diagnostic and predictive roles of neutrophil-lymphocyte ratio for severity of disease in COVID-19 patients[J]. Clin Lab, 2021, 67(12). DOI: 10.7754/Clin.Lab.2021.210449.
[6]
Zhu R, Chen C, Wang Q, et al. Routine blood parameters are helpful for early identification of influenza infection in children[J]. BMC Infect Dis, 2020, 20(1): 864. DOI: 10.1186/s12879-020-05584-5.
[7]
Kalabin A, Mani VRK, Valdivieso SC, et al. Role of neutrophil-to-lymphocyte, lymphocyte-to-monocyte and platelet-to-lymphocyte ratios as predictors of disease severity in COVID-19 patients[J]. Infez Med, 2021, 29(1): 46-53.
[8]
国家卫生健康委员会办公厅，国家中医药管理局办公室. 新型冠状病毒肺炎诊疗方案(试行第九版)[EB/OL]. (2022-03-15)[2022-04-20].

URL    
[9]
国家卫生健康委员会办公厅. 新型冠状病毒肺炎防控方案(第五版).新型冠状病毒肺炎实验室检测技术指南[EB/OL]. (2020-02-21)[2022-04-20].

URL    
[10]
Lu X, Zhang L, Du H, et al. SARSCoV2 infection in children[J]. N Engl J Med, 2020, 382(17): 16631665. DOI: 10.1056/NEJMc2005073.
[11]
吕媛，舒桂华，侯玮玮，等. 扬州地区新型冠状病毒delta变异株感染54例儿童临床特点分析[J]. 临床儿科杂志，2022, 40(4): 252-257. DOI: 10.12372/jcp.2022.21e1264.
[12]
Liguoro I, Pilotto C, Bonanni M, et al. SARS-COV-2 infection in children and newborns: a systematic review[J]. Eur J Pediatr, 2020, 179(7): 1029-1046. DOI: 10.1007/s00431-020-03684-7.
[13]
Ciccullo A, Borghetti A, Zileri Dal Verme L, et al. Neutrophil-to-lymphocyte ratio and clinical outcome in COVID-19: a report from the Italian front line[J]. Int J Antimicrob Agents, 2020, 56(2): 106017. DOI: 10.1016/j.ijantimicag.2020.106017.
[14]
Erdogan T. Role of systemic immune-inflammation index in asthma and NSAID-exacerbated respiratory disease[J]. Clin Respir J, 2021, 15(4): 400-405. DOI: 10.1111/crj.13314.
[15]
Andrews N, Stowe J, Kirsebom F, et al. Effectiveness of COVID-19 booster vaccines against COVID-19-related symptoms, hospitalization and death in England[J]. Nat Med, 2022, 28(4): 831-837. DOI: 10.1038/s41591-022-01699-1.
[16]
Liu L, Zheng Y, Cai L, et al. Neutrophil-to-lymphocyte ratio, a critical predictor for assessment of disease severity in patients with COVID-19[J]. Int J Lab Hematol, 2021, 43(2): 329-335. DOI: 10.1111/ijlh.13374..
[17]
Shahid MF, Malik A, Siddiqi FA, et al. Neutrophil-to-lymphocyte ratio and absolute lymphocyte count as early diagnostic tools for corona virus disease 2019[J]. Cureus, 2022, 14(3): e22863. DOI: 10.7759/cureus.22863.
[18]
Bg S, Gosavi S, Ananda Rao A, et al. Neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and platelet-to-lymphocyte ratios: prognostic significance in COVID-19[J]. Cureus, 2021, 13(1): e12622. DOI: 10.7759/cureus.12622.
[19]
Yildiz E, Cigri E, Dincer Z, et al. High neutrophil/lymphocyte ratios in symptomatic pediatric COVID-19 patients[J]. J Coll Physicians Surg Pak, 2021, 31(7): S93-S98. DOI: 10.29271/jcpsp.2021.
[20]
Anderson R, Feldman C. Review manuscript: mechanisms of platelet activation by the pneumococcus and the role of platelets in community-acquired pneumonia[J]. J Infect, 2017, 75(6): 473-485. DOI: 10.1016/j.jinf.2017.09.013.
[21]
Hirahara T, Arigami T, Yanagita S, et al. Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer[J]. BMC Cancer, 2019, 19(1): 672. DOI: 10.1186/s12885-019-5903-y.
[22]
Eissa M, Shaarawy S, Abdellateif MS, et al. The role of different inflammatory indices in the diagnosis of COVID-19[J]. Int J Gen Med, 2021, 14: 7843-7853. DOI: 10.2147/IJGM.S337488.
[23]
Fleming-Dutra KE, Britton A, Shang N, et al. Association of prior BNT162b2 COVID-19 vaccination with symptomatic SARS-CoV-2 infection in children and adolescents during omicron predominance[J]. JAMA, 2022, 327(22): 2210-2219. DOI: 10.1001/jama.2022.7493.
[24]
Bar-ON YM, Goldberg Y, Mandel M, et al. Protection of BNT162b2 vaccine booster against COVID-19 in Israel[J]. N Engl J Med, 2021, 385(15): 1393-1400. DOI: 10.1056/NEJMoa2114255.
[25]
简丽娟，姚向阳，伍定辉. 新冠肺炎患者核酸转阴时间延长的影响因素分析[J]. 海峡预防医学杂志，2022, 28(3): 14-17.
[26]
龚惠莉，黄汉平，周霞，等. 新型冠状病毒核酸转阴时间相关因素及其对预后的影响[J]．医药导报，2020, 39(6): 811-814. DOI: 10.3870/j.issn.1004-0781.2020.06.015.
[27]
刘波，单南冰，雷习群，等. 新型冠状病毒肺炎患者核酸转阴时间的影响因素及与淋巴细胞亚群的关系[J]. 临床检验杂志，2021, 39(5): 333-336. DOI: 10.13602/j.cnki.jcls.2021.05.03.
[1] 陶宏宇, 叶菁菁, 俞劲, 杨秀珍, 钱晶晶, 徐彬, 徐玮泽, 舒强. 右心声学造影在儿童右向左分流相关疾病中的评估价值[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(10): 959-965.
[2] 刘琴, 刘瀚旻, 谢亮. 基质金属蛋白酶在儿童哮喘发生机制中作用的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 564-568.
[3] 向韵, 卢游, 杨凡. 全氟及多氟烷基化合物暴露与儿童肥胖症相关性研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 569-574.
[4] 王雅楠, 刘丹, 曹正浓, 贾慧敏. 儿童迟发性先天性膈疝患儿的临床诊治特点分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 410-419.
[5] 陈桂华, 钟小玲, 谢雨, 王慧, 谢江, 杨涛毅. 合并肝脏疾病特殊健康状态儿童疫苗预防接种及时性临床分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 431-439.
[6] 雷丽莉, 于晓峰, 王媛媛, 徐迎军. 人鼻病毒感染喘息急性发作儿童外周血NLRP3和TLR4水平及临床意义[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(04): 440-445.
[7] 刘冉佳, 崔向丽, 周效竹, 曲伟, 朱志军. 儿童肝移植受者健康相关生存质量评价的荟萃分析[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 302-309.
[8] 丁荷蓓, 王珣, 陈为国. 七氟烷吸入麻醉与异丙酚静脉麻醉在儿童腹股沟斜疝手术中的应用比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 570-574.
[9] 曾纪晓, 徐晓钢, 王欣星, 刘斐, 兰梦龙, 陶波圆, 梁子建, 叶志华, 罗媛圆. 达芬奇机器人辅助Swenson-like巨结肠根治术[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(04): 239-243.
[10] 中华医学会器官移植学分会, 中华医学会外科学分会外科手术学学组, 中华医学会外科学分会移植学组, 华南劈离式肝移植联盟. 劈离式供肝儿童肝移植中国临床操作指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 593-601.
[11] 刘军, 丘文静, 孙方昊, 李松盈, 易述红, 傅斌生, 杨扬, 罗慧. 在体与离体劈离式肝移植在儿童肝移植中的应用比较[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 688-693.
[12] 张佳臣, 宋红欣. 儿童青少年等效球镜屈光度变化与屈光不正进展相关性的临床研究[J/OL]. 中华眼科医学杂志(电子版), 2024, 14(04): 217-222.
[13] 张琛, 秦鸣, 董娟, 陈玉龙. 超声检查对儿童肠扭转缺血性改变的诊断价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 565-568.
[14] 陈晓胜, 何佳, 刘方, 吴蕊, 杨海涛, 樊晓寒. 直立倾斜试验诱发31 秒心脏停搏的植入心脏起搏器儿童一例并文献复习[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 488-494.
[15] 曹亚丽, 高雨萌, 张英谦, 李博, 杜军保, 金红芳. 儿童坐位不耐受的临床进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 510-515.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号