摘要目的 分析中国10所城市哨点医院内15岁以下严重急性呼吸道感染(SARI)病例分布特征,并分析重症病例发生的危险因素.方法 于2009年12月至2014年6月,以我国10个监测城市的10所哨点医院的呼吸内科、儿内科及重症监护室病房的2 937例SARI病例为研究对象,对其进行咽拭子采集、流感病原学检测以及问卷调查.纳入标准:15岁以下、符合SARI病例定义、完整填写调查表信息的监测科室收治的住院病例.采用秩和检验比较轻症和重症病例间年龄、病程中发病至住入院天数、住院时间、发病至出院或死亡天数的差异.采用x2检验比较轻症和重症病例人口学特征、流感病毒检测阳性率、流感病毒接种率、慢性基础性疾病及临床特征的差异.根据SARI监测方案,按年龄将SARI儿童病例分成两层(＜2和≥2岁组),采用多因素二分类非条件logistic回归分析重症病例的危险因素.结果 2 937例SARI儿童病例中,轻症占97.7％(2 872/2 937),重症占2.3％ (65/2 937),5岁以下占78.8％(2 315/2 937).重症和轻症病例年龄的P50分别为0.4、2.0岁(U=-6.23,P＜0.001),重症和轻症病例慢性基础性疾病患病率分别为32.3％(21/65)、8.4％(240/2 872)(x2=45.03,P＜0.001).流感病毒检测的阳性率为6.5％(190/2 937),轻症、重症病例的阳性率分别为6.5％(186/2 858)、6.2％ (4/65)(x2=0.08,P=0.961).季节性流感疫苗接种率为1.5％(42/2 853),其中轻症病例的接种率为1.5％(42/2 788),高于重症病例(0) (x2=6.09,P=0.048).＜2岁组中,＜11月龄和至少患1种慢性基础性疾病均是患重症SARI的危险因素,其风险分别是12～23月龄和无慢性基础性疾病史病例的4.71(5.35～40.44)、5.61 (2.96～10.63)倍.≥2岁组中,年龄、是否至少患1种慢性基础性疾病、季节性流感疫苗接种史与重症病例相关性无统计学意义,OR(95％CI)值分别为0.92(0.80～1.05)、0.67(0.09～5.05)、0.85 (0.31～2.35).结论 我国10所城市哨点医院内SARI病例以5岁以下病例为主,＜11月龄、至少患1种慢性基础性疾病是产生重症病例的危险因素.

abstractsObjective To investigate clinical and epidemiological characteristics of hospitalized severe acute respiratory illnesses (SARI) patients under 15 years old registered by sentinel hospitals at 10 cities and risk factors analysis of severe illness.Methods The objects of this study were 2 937 SARI patients under 15 years old registered by sentinel surveillance in internal wards,pediatrics wards and intensive care units (ICU) of 10 sentinel hospitals in 10 cities during the period from December 2009 to June 2014.We also collected case report form (CRF) of them and their throat swabs for influenza testing.The inclusion criteria was hospitalized patients who were admitted by surveillance departments,registered by SARI surveillance system,under 15 years old,meeting SARI case definition and with complete CRF.Ranksum test was used to compare the difference of age,the duration including from onset to admission,hospital stay and from onset to discharging/death between mild illness and severe illness.Chi-square test was used to compare the difference of demographic characteristics,influenza psoitive rate,vaccination rate of influenza,chronic medical conditions and clinical characteristics between mild illness and severe illness.Logistic regression was used to analysis risk factors associated with severe illness by two stratifications from SARI surveillance protocol (＜2 years old and ≥2 years old).Results Among 2 937 SARI patients under 15 years old,97.7％ (2 872/2 937) was mild illnesses,and 2.3％ (65/2 937) was severe illnesses.78.8％ (2 315/2 937) was under 5 years old.The median ages of severe illness and mild illness were 0.4 and 2.0 vears old (U=-6.23,P＜0.001).The proportions of severe illness and mild illness with at least one chronic medical condition were 32.3％ (21/65) and 8.4％ (240/2 872) (x-2=45.03,P＜0.001).The positive rate of influenza virus was 6.5％ (190/2 937),which was 6.5％ (186/2 858) for mild illness and 6.2％ (4/65) for severe illness (x2=0.08,P=0.961).The proportion of seasonal influenza vaccination was 1.5％ (42/2 853),which was 1.5％(42/2 788) for mild illness and higher than that for severe illness (0) (x2=6.09,P=0.048).For under 2 years old patients,age＜11 months and with at least one chronic medical condition were risk factors for severe SARI illness,and the risk for SARI patients who was 12-23 months and without medical condition was 14.71 (5.35-40.44) and 5.61(2.96-10.63).For ≥2 years old patients,age,with at least one chronic medical condition and seasonal influenza vaccination history have no association with severe illness,OR(95％CI)was 0.92(0.80-1.05),0.67(0.09-5.05)and 0.85(0.31-2.35),respectively.Conclusion Most of SARI patients registered by 10 urban sentinel hospitals were patients under 5 years old.Age ＜11 months and with at least chronic medical conditions were possible risk factors of severe illness of SARI patients.