儿童病毒性下呼吸道感染的临床和实验室特征

E. Orlova, I. Babachenko, N. Tian, E. Kozyrev, L. A. Alekseeva
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摘要

目的:比较不同病因的病毒性下呼吸道感染的临床和实验室表现特点。目的与方法:回顾性分析2016 - 2022年在儿科研究与传染病临床中心门诊住院的385例患者的医疗资料。纳入标准:年龄1个月~ 17岁;下呼吸道传染病;聚合酶链反应法提取鼻咽拭子呼吸道病毒核酸。入院后,所有儿童都接受了体格检查、耳鼻喉科医生的检查、含白细胞的全血检查、c反应蛋白水平的测定,如有必要,在两个突出部位进行胸部x光检查。结果:呼吸道合胞病毒和鼻病毒在下呼吸道感染的病因结构中占主导地位。不同病因的呼吸道病毒感染在发烧的持续时间和严重程度以及卡他性综合征的表现上存在差异。博卡病毒和鼻病毒感染常引起严重的下呼吸道损伤,并发急性呼吸衰竭。病毒性下呼吸道感染在白细胞图上有中性粒细胞和带细胞增加等变化,这种变化持续4-5天。血象中炎症变化的严重程度取决于疾病的病因。在腺病毒和鼻病毒感染中检测到最显著的变化,如白细胞增多和中性粒细胞绝对计数的增加。结论:儿童病毒性下呼吸道感染具有年龄和临床特点。在患有下呼吸道病毒病变的儿童中,长期发烧和血象中确定的炎症变化,通常与c反应蛋白水平升高相结合,解释了在医疗保健的任何阶段处方抗菌药物的频率。考虑下呼吸道疾病患者呼吸道病毒感染的临床和实验室特点,选择最佳的治疗策略是必要的。
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Clinical and laboratory features of viral lower respiratory tract infections in children
Purpose: to give a comparative characteristic of the clinical and laboratory manifestations of viral lower respiratory tract infections of various etiologies.Object and methods: Medical information of 385 patients, who were hospitalized in the clinic of Pediatric Research and Clinical Center for Infectious Diseases in the period from 2016 to 2022, was retrospectively analyzed. Inclusion criteria: age from 1 month to 17 years; infectious diseases of the lower respiratory tract; extraction of respiratory viral nucleic acids in nasopharyngeal swabs by polymerase chain reaction. Upon admission, all children underwent: a physical examination, an examination by an otorhinolaryngologist, a complete blood test with a leucogram, determination of the level of C-reactive protein, and, if it necessary, a chest X-ray in two projections.Results: Respiratory syncytial virus and rhinovirus dominated in the etiological structure of lower respiratory tract infection. Differences in the duration and severity of fever and manifestations of catarrhal syndrome in respiratory viral infections of various etiologies were established. Boca-virus and rhinovirus infections often caused severe damage of the lower respiratory tract with acute respiratory failure. Viral lower respiratory tract infections have such changes in the leucogram as an increase in neutrophils and band cells, which persist for 4-5 days of the disease. The severity of inflammatory changes in the haemogram depends on the etiology of the disease. The most significant changes, such as leukocytosis and an increase in the absolute count of neutrophils, were detected in adenovirus and rhinovirus infections.Conclusion: There were age and clinical features of viral lower respiratory tract infections in children. Prolonged fever and identified inflammatory changes in the hemogram, often in combination with an increase in the level of C-reactive protein, in children with viral lesions of the lower respiratory tract explain the frequency of prescribing antibacterial drugs at any stage of medical care. To select the optimal therapy tactics, it is necessary to take into account the clinical and laboratory features of respiratory viral infections in patients with diseases of the lower respiratory tract.
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