[Analysis of the clinical features and the risk factors of severe human metapneu movirus-associated community acquired pneumonia in children].

Objective: To investigate the clinical characteristics and the risk factors of severe human metapneumovirus (hMPV)-associated community acquired pneumonia (CAP) in children. Methods: A retrospective case summary was conducted. From December 2020 to March 2022, 721 children who were diagnosed with CAP and tested positive for hMPV nucleic acid by PCR-capillary electrophoresis fragment analysis of nasopharyngeal secretions at the Yuying Children's Hospital, the Second Affiliated Hospital of Wenzhou Medical University were selected as the research objects. The clinical characteristics, epidemiological characteristics and mixed pathogens of the two groups were analyzed. According to CAP diagnostic criteria, the children were divided into the severe group and the mild group. Chi-square test or Mann-Whitney rank and contrast analysis was used for comparison between groups, while multivariate Logistic regression was applied to analyze the risk factors of the severe hMPV-associated CAP. Results: A total of 721 children who were diagnosed with hMPV-associated CAP were included in this study, with 397 males and 324 females. There were 154 cases in the severe group. The age of onset was 1.0 (0.9, 3.0) years, <3 years old 104 cases (67.5%), and the length of hospital stay was 7 (6, 9) days. In the severe group, 67 children (43.5%) were complicated with underlying diseases. In the severe group, 154 cases (100.0%) had cough, 148 cases (96.1%) had shortness of breath and pulmonary moist rales, and 132 cases (85.7%) had fever, 23 cases (14.9%) were complicated with respiratory failure. C-reactive protein (CRP) was elevated in 86 children (55.8%), including CRP≥50 mg/L in 33 children (21.4%). Co-infection was detected in 77 cases (50.0%) and 102 strains of pathogen were detected, 25 strains of rhinovirus, 17 strains of Mycoplasma pneumoniae, 15 strains of Streptococcus pneumoniae, 12 strains of Haemophilus influenzae and 10 strains of respiratory syncytial virus were detected. Six cases (3.9%) received heated and humidified high flow nasal cannula oxygen therapy, 15 cases (9.7%) were admitted to intensive care unit, and 2 cases (1.3%) received mechanical ventilation. In the severe group, 108 children were cured, 42 children were improved, 4 chlidren were discharged automatically without recovery and no death occurred. There were 567 cases in the mild group. The age of onset was 2.7 (1.0, 4.0) years, and the length of hospital stay was 4 (4, 6) days.Compared with the mild group, the proportion of children who age of disease onset <6 months, CRP≥50 mg/L, the proportions of preterm birth, congenital heart disease, malnutrition, congenital airway malformation, neuromuscular disease, mixed respiratory syncytial viruses infection were higher (20 cases (13.0%) vs. 31 cases (5.5%), 32 cases (20.8%) vs. 64 cases (11.3%), 23 cases (14.9%) vs. 44 cases (7.8%), 11 cases (7.1%) vs. 18 cases (3.2%), 9 cases (5.8%) vs. 6 cases (1.1%), 11 cases (7.1%) vs. 12 cases (2.1%), 8 cases (5.2%) vs. 4 cases (0.7%), 10 cases (6.5%) vs. 13 cases (2.3%), χ2=0.42, 9.45, 7.40, 4.94, 11.40, 8.35, 3.52, 6.92, all P<0.05). Multivariate Logistic regression analysis showed that age<6 months (OR=2.51, 95%CI 1.29-4.89), CRP≥50 mg/L (OR=2.20, 95%CI 1.36-3.57), prematurity (OR=2.19, 95%CI 1.26-3.81), malnutrition (OR=6.05, 95%CI 1.89-19.39) were the independent risk factors for severe hMPV-associated CAP. Conclusions: Severe hMPV-associated CAP is most likely to occur in infants under 3 years old and has a higher proportion of underlying diseases and co-infection. The main clinical manifestations are cough, shortness of breath and pulmonary moist rales, fever. The overall prognosis is good. Age<6 months, CRP≥50 mg/L, preterm birth, malnutrition are the independent risk factors for severe hMPV-associated CAP.目的： 探讨重症人偏肺病毒（hMPV）感染致社区获得性肺炎（CAP）（简称hMPV CAP）患儿的临床特点和相关危险因素。 方法： 回顾性队列研究。纳入2020年12月至2022年3月温州医科大学附属第二医院育英儿童医院经鼻咽分泌物PCR-毛细电泳片段分析法检测hMPV核酸阳性的721例CAP患儿为研究对象，收集患儿临床特征、流行病学特点、混合感染情况等信息，根据CAP诊断标准分为重症组和轻症组。采用χ2检验或Mann-Whitney秩和检验进行组间比较，采用多因素Logistic回归分析发生重症hMPV CAP的高危因素。 结果： 721例患儿中男397例、女324例。重症组154例，发病年龄1.0（0.9，3.0）岁，<3岁104例（67.5%），住院时间7（6，9）d；67例（43.5%）患儿合并基础疾病。重症组常见临床表现有咳嗽154例（100.0%），气促和肺部湿啰音各148例（96.1%），发热132例（85.7%），并发呼吸衰竭23例（14.9%）；86例（55.8%）C反应蛋白（CRP）升高，其中33例（21.4%）CRP≥50 mg/L；77例（50.0%）患儿共检出102株其他病原体，其中鼻病毒25株、肺炎支原体17株、肺炎链球菌15株、流感嗜血杆菌12株、呼吸道合胞病毒10株等；6例（3.9%）予温湿化高流量给氧，15例（9.7%）住重症监护室，2例（1.3%）接受机械通气；治愈108例、好转42例、未愈自动出院4例、无死亡病例。轻症组567例，发病年龄2.7（1.0~4.0）岁，住院时间4（4，6）d。重症组发病年龄<6月龄、CRP≥50 mg/L、早产、先天性心脏病、营养不良、先天性气道发育异常、神经肌肉疾病、混合呼吸道合胞病毒感染的比例均高于轻症组［20例（13.0%）比31例（5.5%），32例（20.8%）比64例（11.3%），23例（14.9%）比44例（7.8%），11例（7.1%）比18例（3.2%），9例（5.8%）比6例（1.1%），11例（7.1%）比12例（2.1%），8例（5.2%）比4例（0.7%），10例（6.5%）比13例（2.3%），χ2=0.42、9.45、7.40、4.94、11.40、8.35、3.52、6.92，均P<0.05］。多因素Logistic回归分析示发病年龄<6月龄（OR=2.51，95%CI 1.29~4.89）、CRP≥50 mg/L（OR=2.20，95%CI 1.36~3.57）、早产（OR=2.19，95%CI 1.26~3.81）、营养不良（OR=6.05，95%CI 1.89~19.39）是重症hMPV CAP的独立危险因素。 结论： 重症hMPV CAP高发于3岁以下婴幼儿，易合并基础疾病及其他病原感染，主要临床表现为咳嗽、气促及肺部湿啰音、发热，总体预后良好。发病年龄<6月龄、CRP≥50 mg/L、早产、营养不良是发生重症hMPV CAP的独立危险因素。.