突发公共卫生事件后喘息患儿常见呼吸道病原分析及临床特征研究

Analysis of Common Respiratory Pathogens and Clinical Characteristics in Children with Wheezing after the Public Health Emergencies

摘要: 目的：明确此次突发公共卫生事件管控措施调整前后，儿童喘息性疾病的病原谱变迁及临床特征差异，为儿童呼吸道感染性疾病的精准诊疗与防控提供流行病学依据。方法：回顾性收集2020年1月23日至2024年12月31日内蒙古自治区人民医院临床表现有喘息症状的1398例患儿进行呼吸道病原检测。结果：1398例患儿中，病原检出总阳性率41.6%，突发公共卫生事件期间病原总阳性率34.7%，突发公共卫生事件后期总阳性率升至63.9% (P < 0.001)，呼吸道合胞病毒(RSV 13.9%)、鼻病毒(RV 11.2%)等病毒大量出现，混合感染率从4.6%增至9.1% (P < 0.001)；<1岁婴儿以RSV为主要病原，随年龄增长RSV检出率下降；1岁以上儿童以MP为主，且年龄越大MP检出率越高；1~2岁与3~6岁组事件后期RSV、RV、博卡病毒(BoV)、副流感病毒(Pinf)检出率显著上升(P < 0.05)。冬季病原检出率最高，春季最低；RSV、偏肺病毒(MPV)冬季高发，RV、Pinf秋季高发；事件期间FluA、FluB冬季高峰，后期转为秋季高发(P < 0.05)；MP全年散发。CP、BoV、FluB感染组住院天数最长，CP、BoV组呼吸困难、紫绀在BoV组发生率最高，RV组鼻炎发生率显著高于其余各组。结论：突发公共卫生事件显著改变儿童喘息性疾病病原谱，后期RSV、RV等病毒反弹明显；病原分布具有年龄与季节特异性，且不同病原感染的临床特征存在差异，临床需结合时期、年龄、季节及症状精准预判病原，优化诊疗与防控策略。

Abstract: Objective: To clarify the changes in pathogen spectrum and differences in clinical characteristics of wheezing diseases in children before and after the adjustment of public health emergencies pre-vention and control measures, and to provide epidemiological evidence for precise diagnosis, treatment, and prevention of childhood respiratory infectious diseases in the post-pandemic era. Methods: A retrospective analysis was conducted on 1398 children with wheezing symptoms who underwent respiratory pathogen detection at the Inner Mongolia Autonomous Region People’s Hos-pital from January 23, 2020 to December 31, 2024. Results: Among the 1398 children, the overall positive rate of pathogen detection was 41.6%. During the public health emergencies pandemic pe-riod, the overall positive rate was 34.7%, which increased to 63.9% in the post-pandemic period (P < 0.001). Viruses such as respiratory syncytial virus (RSV, 13.9%) and rhinovirus (RV, 11.2%) emerged in large numbers, and the rate of mixed infections increased from 4.6% to 9.1% (P < 0.001). For infants under 1 year old, RSV was the main pathogen, and its detection rate decreased with increasing age; for children over 1 year old, Mycoplasma pneumoniae (MP) was the dominant pathogen, and its detection rate increased with age. In the post-pandemic period, the detection rates of RSV, RV, bocavirus (BoV), and parainfluenza virus (Pinf) increased significantly in children aged 1~2 years and 3~6 years (P < 0.05). The pathogen detection rate was highest in winter and lowest in spring: RSV and metapneumovirus (MPV) were prevalent in winter, while RV and Pinf were prevalent in autumn. During the pandemic, influenza A (FluA) and influenza B (FluB) peaked in winter, but shifted to autumn in the post-pandemic period (P < 0.05); MP was prevalent throughout the year. The hospitalization duration was longest in children infected with Chlamydia pneumoniae (CP), BoV, and FluB. The incidence of dyspnea was highest in CP and BoV groups, and the incidence of cyanosis was highest in the BoV group. The incidence of rhinitis in the RV group was significantly higher than in other groups. Conclusion: The public health emergencies pandemic sig-nificantly altered the pathogen spectrum of wheezing diseases in children, with a marked rebound of viruses such as RSV and RV in the post-pandemic period. Pathogen distribution exhibits age and seasonal specificity, and clinical characteristics vary across different pathogen infections. Clinically, precise pathogen prediction should be based on the period, age, season, and symptoms to optimize diagnosis, treatment, and prevention strategies.