Abstract: Objective　To explore the clinical characteristics of children with pertussis and the risk factors of severe pertussis in order to provide reference for clinical diagnosis and treatment. Methods　The Central Laboratory of the Capital Institute of Pediatrics was used as the testing center to review the case data of 114 inpatients with whooping cough diagnosed from January to December 2019. According to the severity of the children’s condition and whether they were associated with other pathogenic infections. 73 cases of whooping cough were included in the single pertussis group and 41 cases were in mixed infection group. A hundred cases were the common group and 14 cases in the severe group. Single factor comparisons were performed between the groups，and the risk factors of severe pertussis were analyzed by binary Logistic regression. Results　1）A total of 66 cases（62.2%） of whooping cough occurred in autumn and winter. The predominant children were ≤6 months old，with a total of 79 cases（69.3%）. Totally 89 cases（78.1%） were not immunized，and 25 cases（21.9%） were immunized. 2）Univariate analysis showed that the mixed infection group was more likely to have hypoxemia，three depression sign，fever，and pulmonary rales than the simple pertussis group（P＜0.05）. The proportion of patients who had a history of premature delivery，bruising after coughing，three depression sign，fever，pulmonary rales，pneumonia，and mixed infection in severe group was higher than that in the ordinary group（P＜0.05）. The mixed infection group and severe group had longer hospital stay than the single pertussis group and common group（P＜0.05）. The peak value of white blood cells in the severe group was higher than that in the common group（P＜0.05）. Logistic regression analysis showed that increased WBC peak was arisk factor for severe pertussis（OR＝1.096，P＜0.05）. 3）A total of 114 cases of confirmed children were treated with macrolide antibiotics. Only 10 cases（8.8%） were treated within 7 days of the disease course，and 33 cases（28.9%） were treated within 8 to 14 days of the disease course. The rest were treated more than 14 days of the course of disease，of which 5 severely ill children were treated more than 21 days. 4）Children with severe whooping cough who were less than 4 months old were prone to severe complications，such as pneumonia，whooping cough encephalopathy，and cardiopulmonary failure. Among them，8 children were treated with invasive ventilation. After active treatment，one child died，and therest were improved and discharged. Conclusion　Whooping cough is more common in the babies under 6 months old whoare not immunized and the babies often require hospitalization. The incidence of complications in younger babies with whooping cough is higher. Co-infection and delayed medication may aggravate whooping cough and extend the length of hospital stay. It helps to judge disease severity to monitor the peak value of white blood cells.

Key words: whooping cough, clinical features, risk factors

摘要： 目的　分析儿童百日咳临床特征及重症百日咳发生的危险因素，为临床诊治提供参考。方法　以首都儿科研究所中心实验室为检测中心，回顾性分析2019年1月至12月确诊的114例百日咳住院患儿病例资料。根据是否合并其他病原感染，分为单纯百日咳组73例，混合感染组41例；根据病情程度分为普通百日咳组100例，重症百日咳组14例。组间进行单因素比较，同时行二元Logistic回归分析重症百日咳的危险因素。结果　（1）百日咳好发于秋冬季共66例（62.2%）。患儿以≤6月龄为主，共79例（69.3%）。未免疫89例（78.1%），免疫25例（21.9%）。（2）单因素分析比较得出，混合感染组较单纯百日咳组更易出现血氧下降、三凹征、发热、肺部湿啰音（P＜0.05）；重症组中有早产史、咳嗽后青紫、三凹征、发热、肺部湿啰音、肺炎和混合感染患者占比高于普通组（P＜0.05）；混合感染组、重症组较单纯百日咳组、普通组住院时间更长（P＜0.05）；重症组白细胞峰值较普通组高（P＜0.05），Logistic回归分析显示白细胞峰值高是重症百日咳的危险因素（OR＝1.096，P＜0.05）。（3）114例确诊患儿均使用大环内酯类抗生素治疗，10例（8.8%）患儿在病程7 d内用药，33例（28.9%）在病程8～14 d用药，余均＞病程14 d用药，其中5例重症患儿＞病程21 d用药。（4）≤4月龄的重症百日咳患儿易并发肺炎、百日咳脑病、心肺衰竭等严重并发症，其中8例患儿行有创通气治疗。经积极治疗，1例患儿死亡，余均好转出院。结论　≤6月龄、未免疫的小婴儿百日咳发病多见，常需住院治疗，小月龄的百日咳患儿并发症发生率更高。合并感染、延迟用药可能会加重百日咳病情，延长住院时间。监测血白细胞峰值有助于病情程度的判断。

关键词: 百日咳, 临床特征, 危险因素