广州市儿童和青年新型冠状病毒Delta变异株感染患者临床特征

目的探讨儿童和青年新型冠状病毒(SARS-CoV-2)Delta变异株患者的临床特征。方法选取广州医科大学附属市八医院2021年5月21日—6月18日收治的SARS-CoV-2 Delta突变株感染者,根据年龄分为儿童组(2～14岁)和青年组(15～35岁),比较两组患者临床、实验室指标及影像学的差异。结果儿童组21例,青年组24例,两组均无重症患者。儿童以家庭聚集性发病为特征,青年组普通型比儿童组更常见(66.7%VS 33.3%,P0.05)。与青年组临床表现比较,儿童组咳嗽(33.3%VS 87.5%)、咳痰(33.3%VS 66.7%)和咽喉不适(28.6%VS 70.8%)少见(均P0.05),儿童发热时间更短(2.5 d VS 4 d,P0.05),但两组患者发热(76.2%VS 83.3%)差异无统计学意义。与青年组生化学指标比较,基线时儿童组C-反应蛋白(CRP)、血清淀粉样蛋白A(SAA)和白介素-6(IL-6)更低(均P0.05),但淋巴细胞(LYM)、嗜酸性粒细胞(EOS)、乳酸脱氢酶(LDH)和肌酸激酶同工酶(CK-MB)更高;第1周儿童组CRP和SAA更低,但LYM、EOS、LDH和CK-MB更高(均P0.05)。儿童基线CK-MB和LDH升高更常见(均P0.05)。儿童组基线时LYM减少5例(23.8%),EOS减少3例(14.3%),第1周LYM和EOS均恢复正常。胸部CT显示儿童组7例(33.3%)肺部感染,单侧受累为主;青年组16例(66.7%)肺部感染,双肺受累为主。儿童组SARS-CoV-2核酸转阴时间中位日数为17(12,25)d,青年组核酸转阴时间中位日数为19(15,21)d,两组患者均预后良好。结论儿童SARS-CoV-2 Delta变异株感染以家庭聚集性发病为主要特征。与青年患者比较,儿童患者呼吸道症状、炎症反应、免疫细胞和肺损伤更轻,免疫细胞恢复更快。儿童患者基线CK-MB和LDH升高更常见,需关注急性心肌损伤的可能性。青年和儿童患者SARS-CoV-2核酸转阴时间长,需延长监测上呼吸道核酸的时间。

Clinical characteristics of infection with SARS-CoV-2 Delta variant in children and youth in Guangzhou City

Objective To explore the clinical characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant in children and youth. Methods Patients infected with SARS-CoV-2 Delta variant and treated in Guangzhou Eighth People''s Hospital, Guangzhou Medical University from May 21 to June 18, 2021 were selected, they were divided into children group (2-14 years old) and youth group (15-35 years old), differences in clinical, laboratory indicators and chest CT imaging between two groups of patients were compared. Results There were 21 cases in children group and 24 cases in youth group, there was no severe cases in two groups. Children were characterized by family aggregation, the common type was more frequent in youth group than in children group (66.7% vs 33.3%, P < 0.05). Compared with youth group, cough (33.3% vs 87.5%), expectoration (33.3% vs 66.7%) and throat discomfort (28.6% vs 70.8%) were all lower in children group (all P < 0.05), the duration of fever in children was shorter (2.5 d vs 4 d, P < 0.05), however, there was no significant difference in fever (76.2% vs 83.3%) between two groups of patients. Compared with biochemical indicators of youth group, levels of C-reactive protein (CRP), serum amyloid A (SAA) and interleukin-6 (IL-6) in children group were lower at baseline (all P < 0.05), but levels of lymphocyte (LYM), eosinophil (EOS), lactate dehydrogenase (LDH) and creatine kinase isoenzyme (CK-MB) were higher; at the first week, CRP and SAA were lower, but LYM, EOS, LDH and CK-MB were higher in children group (all P < 0.05). Elevation of CK-MB and LDH were more frequent in children at baseline (both P < 0.05). In children group, LYM decreased in 5 cases (23.8%) and EOS decreased in 3 cases (14.3%) at baseline, but both LYM and EOS returned to normal at the first week. Chest CT showed that 7 cases (33.3%) had pulmonary infection in children group, mainly unilateral involvement; in youth group, 16 cases (66.7%) showed pulmonary infection, mainly bilateral lung involvement. The median time of nucleic acid negative conversion of SARS-CoV-2 was 17 (12, 25) days in children group and 19 (15, 21) days in youth group, prognosis of two groups of patients were good. Conclusion SARS-CoV-2 Delta variant of children are mainly chara-cterized by family aggregation. Compared with youth patients, respiratory symptoms, inflammatory reaction, the injury of immune cells and lung in children patients are slighter, while immune cells recover faster. Elevation of CK-MB and LDH are more frequent in children at baseline, and attention should be paid to the possibility of acute myocardial injury. It takes a long time for virus nucleic acid of SARS-CoV-2 to turn negative in youth and children patients, so it is necessary to extend the time of monitoring nucleic acid of upper respiratory tract.