探讨0~2个月龄百日咳婴儿的临床特征及进展为重症百日咳的影响因素。

选择2024年1至12月西安市儿童医院收治的78例0~2个月龄百日咳婴儿的临床病例资料为研究对象。根据百日咳婴儿病情严重程度，将其分为研究组(n＝18，重症百日咳婴儿)和对照组(n＝60，轻症百日咳婴儿)，采用回顾性分析法对2组婴儿的一般资料、临床表现及实验室检查结果进行统计学分析。采用多因素非条件logistic回归分析重症百日咳发生的独立影响因素，并基于影响因素构建预测模型。采用受试者工作特征(ROC)曲线评估2组婴儿各项指标，并构建预测低龄百日咳婴儿进展为重症百日咳联合模型(以下简称为联合预测模型)对婴儿进展为重症百日咳的预测效能。本研究遵循的程序符合西安市儿童医院伦理委员会制定的相关标准，并获得该伦理委员会批准(批件号：2024-010-01)。

①这78例婴儿均以阵发性痉挛性咳嗽为主要临床表现(100.0%)，其次为咳嗽时面色潮红(43.6%，34/78)及发绀(39.7%，31/78)，而吸气性鸡鸣样回声和咳后呕吐发生率仅为15.4%(12/78)和10.3%(8/78)。②研究组婴儿入院时体重低于对照组[4.0 kg(3.6，4.5 kg) vs 5.0 kg(4.5，5.5 kg)]，咳嗽时发绀发生率高于对照组(66.7% vs 31.7%)，并且差异均有统计学意义(P<0.05)；研究组婴儿的住院时间长于对照组[11.0 d(8.0，16.5 d) vs 8.0 d(6.3，10.0 d)]，差异亦有统计学意义(P＝0.001)。③多因素非条件logistic回归分析结果显示，入院时体重(OR＝0.169，95%CI：0.059~0.485，P＝0.001)，咳嗽时发绀(OR＝3.719，95%CI：1.046~13.220，P＝0.042)均是0~2个月百日咳婴儿进展为重症百日咳的影响因素。基于咳嗽时发绀和入院时体重建立联合预测模型，Hosmer-Lemeshow拟合优度检验显示该联合预测模型拟合良好(χ²＝6.27，P＝0.508)。④ROC曲线分析结果显示，入院时婴儿体重、咳嗽时发绀及联合预测模型预测重症百日咳的曲线下面积(AUC)分别为0.810(95%CI：0.697~0.924)，0.675(95%CI：0.531~0.819)和0.841(95%CI：0.721~0.961)。

本研究0~2个月龄百日咳婴儿最常见的临床表现为阵发性痉挛性咳嗽、咳嗽时面色潮红及发绀。入院时体重和咳嗽时发绀二者联合，对0~2个月龄百日咳婴儿进展为重症百日咳具有一定的早期预测价值。

To analyze clinical features of pertussis in infants of aged 0-2 months and to identify risk factors for progression to severe disease.

Clinical data of 78 infants with pertussis aged 0-2 months who were hospitalized in Xi′an Children′s Hospital from January to December 2024 were retrospectively analyzed.They were divided into study group (n=18, severe pertussis) and control group (n=60, mild pertussis) according to the diagnostic criteria for severe pertussis. General clinical data, clinical manifestations, and laboratory results were collected and compared between the two groups by statistical methods. Multivariate unconditional logistic regression was used to identify factors influencing the development of severe pertussis, and a predictive model was constructed based on these factors. Receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of each individual factor and the combined model for severe pertussis. This study followed the standards set by the Ethics Committee of Xi′an Children′s Hospital and was approved by the committee (Approval No. 2024-010-01).

① All 78 children presented with paroxysmal spasmodic cough (100.0%), followed by facial flushing during coughing (43.6%, 34/78) and cyanosis during coughing (39.7%, 31/78), while inspiratory whooping and post-tussive vomiting occurred in only 15.4% (12/78) and 10.3% (8/78), respectively. ② The study group had lower admission body weight than the control group [4.0 kg(3.6, 4.5 kg) vs 5.0 kg(4.5, 5.5 kg), P<0.001], and a higher incidence of cyanosis during coughing (66.7% vs 31.7%), with statistically significant differences between two groups (P<0.05). Additionally, study group had a longer hospital stay than control group [11.0 d (8.0, 16.5 d) vs 8.0 d(6.3, 10.0 d)], and the difference was also statistically significant (P=0.001).③ Multivariate unconditional logistic regression analysis showed that admission body weight (OR=0.169, 95%CI: 0.059-0.485, P=0.001) and cyanosis during coughing (OR=3.719, 95%CI: 1.046-13.220, P=0.042) were factors influencing the progression to severe pertussis. A combined predictive model was established based on cyanosis during coughing and admission body weight, and the Hosmer-Lemeshow goodness-of-fit test indicated good model calibration (χ²=6.27, P=0.508). ④ ROC curve analysis showed that the area under the curve (AUC) of admission body weight, cyanosis during coughing, and the combined model for predicting severe pertussis were 0.810 (95%CI: 0.697-0.924), 0.675 (95%CI: 0.531-0.819), and 0.841 (95%CI: 0.721-0.961), respectively.

The most common clinical manifestations of infants with pertussis aged 0-2 months were paroxysmal spasmodic cough, facial flushing during coughing, and cyanosis during coughing. The combination of admission body weight and cyanosis during coughing showed good early predictive value for progressing to severe pertussis.