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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
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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]. 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]. 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
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