摘要目的 探讨麻疹患儿死亡危险因素,为儿童麻疹的死亡风险评估提供依据.方法 回顾性分析2009年11月至2010年6月河北省儿童医院住院治疗的麻疹患儿临床资料,根据预后不同,将患儿分为痊愈组和死亡组.收集患儿人口学特征和临床资料,采用单因素分析,对有统计学意义的因素进行共线性诊断,共线性诊断后的因素纳入多因素条件Logistic回归分析模型,采用逐步前进法,以选人P≤0.05,剔除P≥0.10的变量为检验水准,探讨麻疹患儿死亡危险因素.结果 研究期间共纳入932例麻疹患儿,其中16例死亡,住院患儿病死率为1.72％.16例死亡患儿中,男9例,女7例,年龄6～44个月,15例居住在农村；14例未接种或未规范接种麻疹疫苗,11例存在多种基础疾病,分别为呼吸系统疾病5例、先天性心脏病1例、神经系统疾病2例和营养不良2例,以及1例患儿为先天性心脏病合并呼吸系统疾病；16例患儿均合并肺炎,15例合并气胸、纵隔气肿、呼吸衰竭、急性呼吸窘迫综合征等严重呼吸道并发症.单因素回归分析表明,预后的危险因素有年龄＞8个月(OR ＝2.751,P＝0.007)、患有基础疾病(OR＝32.961,P＝0.000)、肺炎OR=11.911,P=0.017)、发热(OR＝29.844,P=0.000)、WBC升高(OR=4.816,P＝ 0.000)、Hb降低(OR=2.135,P＝0.017)、ALT升高(OR＝2.672,P＝0.006)、合并严重呼吸道并发症(OR=82.818,P=0.000).多因素回归分析结果显示,合并基础疾病(OR＝ 35.390,P＝0.000)、WBC升高(OR=19.370,P=0.000)、有严重呼吸道并发症(OR=13.696,P＝0.016)是影响预后的危险因素.结论 患有基础疾病、WBC升高、有严重呼吸道并发症是麻疹患儿死亡的独立危险因素.

abstractsObjective To explore the risk factors related to mortality in subjects with measles,and to provide reference for death risk assessment in measles affected children.Methods A retrospective study was conducted among patients with measles who were hospitalized in Hebei Children's Hospital from November 2009 to June 2010.Patients were classified into cure group and death group according to disease outcomes.Demographic and clinical data were collected and compared by univariate analysis.Collinearity diagnostics were performed among variates with statistical significance,which were further analyzed by multivariate Logistic regression analysis to explore risk factors for death in children with measles.Results A total of 932 patients were included,among which 16 (1.72％) were fatal.Among the death cases that aged 6 to 44 months,9 were males; 15 cases lived in rural areas; 14 cases had irregular implementation of measles vaccination; 11 cases had underlying diseases,including respiratory diseases in 5 cases,congenital heart disease in 1 cases,neurological disorder in 2 cases,malnutrition in 2 cases,and congenital heart disease with respiratory disease in 1 case.All the death cases were complicated by pneumonia,and 15 of them developed serious respiratory complications including pneumothorax,mediastinal emphysema,respiratory failure and acute respiratory distress syndrome (ARDS).In univariate analysis,elder than 8 months (OR=2.751,P=0.007),underlying diseases (OR=32.961,P＝0.000),pneumonia (OR=11.911,P=0.017),hyperpyrexia (OR=29.844,P=0.000),elevation of peripheral blood leucocytes (OR =4.816,P=0.000) and alanine transaminase (OR=2.672,P=0.006),decreased hemoglobin (OR=2.135,P=0.017) and serious respiratory complications (OR=82.818,P=0.000) were identified as risk factors of poor prognosis.Multivariate Logistic regression analysis showed that death was significantly associated with underlying diseases (OR=35.390,P =0.000),elevation of peripheral blood leucocytes (OR=19.370,P=0.000) and serious respiratory complications (OR=13.696,P=0.016).Conclusion Underlying diseases,elevation of peripheral blood leucocytes and serious respiratory complications are identified as independent risk factors for death in measles affected children.