Clinical characteristics and influencing factors of severe pertussis in infants between 0-2 months of age

doi:10.3877/cma.j.issn.1673-5250.2026.05.005

Objective

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

Methods

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).

Results

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.

Conclusions

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.

Key words: Whooping cough, Risk factors, Logistic models, Forecasting, Body weight, Cyanosis, Infant

表1 本研究78例0~2个月龄百日咳婴儿一般资料及临床表现

项目	结果	项目	结果
性别[例数(%)]		入院时体重[kg，M(Q₁，Q₃)]	4.8(4.1，5.4)
男性	48(61.5)	接触来源[例数(%)]^a	52(66.7)
女性	30(38.5)	父/母	20(38.4)
发病日龄(d，±s)	30.9±11.6	兄/姐	16(30.8)
出生胎龄[例数(%)]		其他家庭成员	16(30.8)
足月儿(≥37周)	74(94.9)	临床表现[例数(%)]
早产儿(<37周)	4(5.1)	阵发性痉挛性咳嗽	78(100.0)
分娩方式[例数(%)]		吸气性鸡鸣样回声	12(15.4)
自然分娩	32(41.0)	咳后呕吐	8(10.3)
剖宫产术分娩	46(59.0)	咳嗽发作时面色潮红	34(43.6)
辅助生殖[例数(%)]	2(2.6)	咳嗽时发绀	31(39.7)
双胎[例数(%)]	2(2.6)	呼吸衰竭	10(12.8)
喂养方式[例数(%)]		发热	8(10.3)
母乳喂养	23(29.5)	呼吸暂停	8(10.3)
人工喂养	20(25.6)	鼻塞	6(7.7)
混合喂养	35(44.9)	低氧血症	4(5.1)
咳嗽病例接触史[例数(%)]		声音嘶哑	3(3.8)
有	52(66.7)	抽搐	2(2.6)
无	26(33.3)

表1 本研究78例0~2个月龄百日咳婴儿一般资料及临床表现

项目	结果	项目	结果
性别[例数(%)]		入院时体重[kg，M(Q₁，Q₃)]	4.8(4.1，5.4)
男性	48(61.5)	接触来源[例数(%)]^a	52(66.7)
女性	30(38.5)	父/母	20(38.4)
发病日龄(d，±s)	30.9±11.6	兄/姐	16(30.8)
出生胎龄[例数(%)]		其他家庭成员	16(30.8)
足月儿(≥37周)	74(94.9)	临床表现[例数(%)]
早产儿(<37周)	4(5.1)	阵发性痉挛性咳嗽	78(100.0)
分娩方式[例数(%)]		吸气性鸡鸣样回声	12(15.4)
自然分娩	32(41.0)	咳后呕吐	8(10.3)
剖宫产术分娩	46(59.0)	咳嗽发作时面色潮红	34(43.6)
辅助生殖[例数(%)]	2(2.6)	咳嗽时发绀	31(39.7)
双胎[例数(%)]	2(2.6)	呼吸衰竭	10(12.8)
喂养方式[例数(%)]		发热	8(10.3)
母乳喂养	23(29.5)	呼吸暂停	8(10.3)
人工喂养	20(25.6)	鼻塞	6(7.7)
混合喂养	35(44.9)	低氧血症	4(5.1)
咳嗽病例接触史[例数(%)]		声音嘶哑	3(3.8)
有	52(66.7)	抽搐	2(2.6)
无	26(33.3)

表2 本研究78例0~2个月龄百日咳婴儿的实验室及影像学检查结果比较

项目	结果
实验室检查项目
WBC [×10⁹/L，M(Q₁，Q₃)]	13.3(9.8，17.4)
LYM [×10⁹/L，M(Q₁，Q₃)]	8.6(6.6，11.1)
hs-CRP [mg/L，M(Q₁，Q₃)]	0.3(0.2，0.5)
PCT[ng/mL，M(Q₁，Q₃)]	0.06(0.05，0.09)
CK-MB异常[例数(%)]	38(48.7)
肝功能异常[例数(%)]	9(11.5)
胸部影像学检查
肺炎[例数(%)]	41(52.6)
支气管炎[例数(%)]	37(47.4)

表2 本研究78例0~2个月龄百日咳婴儿的实验室及影像学检查结果比较

项目	结果
实验室检查项目
WBC [×10⁹/L，M(Q₁，Q₃)]	13.3(9.8，17.4)
LYM [×10⁹/L，M(Q₁，Q₃)]	8.6(6.6，11.1)
hs-CRP [mg/L，M(Q₁，Q₃)]	0.3(0.2，0.5)
PCT[ng/mL，M(Q₁，Q₃)]	0.06(0.05，0.09)
CK-MB异常[例数(%)]	38(48.7)
肝功能异常[例数(%)]	9(11.5)
胸部影像学检查
肺炎[例数(%)]	41(52.6)
支气管炎[例数(%)]	37(47.4)

表3 本研究0~2个月龄百日咳婴儿治疗及临床转归

项目	结果
大环内酯类抗菌药物使用时机[例数(%)]^a
发病7 d内	45(57.7)
发病7 d后	33(42.3)
其他治疗措施[例数(%)]
糖皮质激素	18(23.1)
静脉注射用人免疫球蛋白	17(21.8)
换血治疗	1(1.3)
住院时间[d，M(Q₁，Q₃)]	8.5(7.0，11.0)
ICU入住率[例数(%)]^b	6(7.7)
诊断为重症百日咳占比[例数(%)]	18(23.1)

表3 本研究0~2个月龄百日咳婴儿治疗及临床转归

项目	结果
大环内酯类抗菌药物使用时机[例数(%)]^a
发病7 d内	45(57.7)
发病7 d后	33(42.3)
其他治疗措施[例数(%)]
糖皮质激素	18(23.1)
静脉注射用人免疫球蛋白	17(21.8)
换血治疗	1(1.3)
住院时间[d，M(Q₁，Q₃)]	8.5(7.0，11.0)
ICU入住率[例数(%)]^b	6(7.7)
诊断为重症百日咳占比[例数(%)]	18(23.1)

表4 本研究2组百日咳婴儿的临床特征比较

组别	例数	发病日龄(d，±s)	男性[例数(%)]	入院时体重[kg，M(Q₁，Q₃)]	咳嗽患者接触史[例数(%)]	痉挛性咳嗽[例数(%)]	咳嗽时发绀[例数(%)]	咳嗽发作时颜面潮红[例数(%)]	吸气性鸡鸣样回声[例数(%)]
研究组	18	28.0±13.9	8(44.4)	4.0(3.6, 4.5)	14(77.8)	18(100.0)	12(66.7)	5(27.8)	4(22.2)
对照组	60	31.8±10.8	40(66.7)	5.0(4.5, 5.5)	38(63.3)	60(100.0)	19(31.7)	29(48.3)	8(13.3)
统计量		t＝－1.21	χ²＝2.89	Z＝－3.98	χ²＝1.30	－^a	χ²＝7.08	χ²＝2.38	χ²＝0.29
P值		0.231	0.089	<0.001	0.254	－^a	0.008	0.123	0.586
组别	例数	咳后呕吐[例数(%)]	发热[例数(%)]	WBC[×10⁹/L，M(Q₁，Q₃)]	LYM [×10⁹/L，M(Q₁，Q₃)]	胸部影像学检查提示肺炎[例数(%)]	大环内酯类抗菌药物使用时机在发病7 d内[例数(%)]	住院时间[d，M(Q₁，Q₃)]
研究组	18	1(5.6)	2(11.1)	15.3(10.6, 23.1)	9.1(6.5, 13.1)	13(72.2)	9(50.0)	11.0(8.0, 16.5)
对照组	60	7(11.7)	6(10.0)	12.9(9.6, 16.9)	8.3(6.4, 10.9)	28(46.7)	36(60.0)	8.0(6.3, 10.0)
统计量		χ²＝0.09	χ²<0.001	Z＝－1.46	Z＝－0.63	χ²＝3.63	χ²＝0.57	Z＝－3.21
P值		0.759	>0.999	0.145	0.526	0.057	0.451	0.001

表4 本研究2组百日咳婴儿的临床特征比较

组别	例数	发病日龄(d，±s)	男性[例数(%)]	入院时体重[kg，M(Q₁，Q₃)]	咳嗽患者接触史[例数(%)]	痉挛性咳嗽[例数(%)]	咳嗽时发绀[例数(%)]	咳嗽发作时颜面潮红[例数(%)]	吸气性鸡鸣样回声[例数(%)]
研究组	18	28.0±13.9	8(44.4)	4.0(3.6, 4.5)	14(77.8)	18(100.0)	12(66.7)	5(27.8)	4(22.2)
对照组	60	31.8±10.8	40(66.7)	5.0(4.5, 5.5)	38(63.3)	60(100.0)	19(31.7)	29(48.3)	8(13.3)
统计量		t＝－1.21	χ²＝2.89	Z＝－3.98	χ²＝1.30	－^a	χ²＝7.08	χ²＝2.38	χ²＝0.29
P值		0.231	0.089	<0.001	0.254	－^a	0.008	0.123	0.586
组别	例数	咳后呕吐[例数(%)]	发热[例数(%)]	WBC[×10⁹/L，M(Q₁，Q₃)]	LYM [×10⁹/L，M(Q₁，Q₃)]	胸部影像学检查提示肺炎[例数(%)]	大环内酯类抗菌药物使用时机在发病7 d内[例数(%)]	住院时间[d，M(Q₁，Q₃)]
研究组	18	1(5.6)	2(11.1)	15.3(10.6, 23.1)	9.1(6.5, 13.1)	13(72.2)	9(50.0)	11.0(8.0, 16.5)
对照组	60	7(11.7)	6(10.0)	12.9(9.6, 16.9)	8.3(6.4, 10.9)	28(46.7)	36(60.0)	8.0(6.3, 10.0)
统计量		χ²＝0.09	χ²<0.001	Z＝－1.46	Z＝－0.63	χ²＝3.63	χ²＝0.57	Z＝－3.21
P值		0.759	>0.999	0.145	0.526	0.057	0.451	0.001

表5 本研究0~2个月龄婴儿重症百日咳影响因素的多因素非条件logistic回归分析

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
咳嗽时发绀(vs无)	1.313	0.647	4.120	0.042	3.719	1.046~13.220
入院时体重(连续变量)	—1.776	0.537	10.950	0.001	0.169	0.059~0.485
常数项	6.121	2.345	6.813	0.009	455.386	—

表5 本研究0~2个月龄婴儿重症百日咳影响因素的多因素非条件logistic回归分析

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
咳嗽时发绀(vs无)	1.313	0.647	4.120	0.042	3.719	1.046~13.220
入院时体重(连续变量)	—1.776	0.537	10.950	0.001	0.169	0.059~0.485
常数项	6.121	2.345	6.813	0.009	455.386	—

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