关键词: 重症百日咳, 儿童, 肺动脉高压, 白细胞升高

Abstract: Objective    To analyze the clinical characteristics of severe pertussis in children and explore the risk factors of the prognosis. Methods    A total of 54 children diagnosed with severe pertussis who were hospitalized in the PICU of Guangzhou Women and Children's Medical Center from August 2023 to February 2024 were included. Group the enrolled children according to whether tohave undergone blood exchange or mechanical ventilation， and compare the differences in clinical characteristics among the groups. Use Kaplan-Meier survival curves and Log-rank tests to compare differences in survival rates among the groups of differentwhite blood cell and lymphocyte levels， presence or absence of pulmonary hypertension and tricuspid regurgitation; univariate and multivariate COX regression equation methods were used to analyze risk factors affecting prognosis of pediatric patients. Results    A total of 54 children with severe pertussis were included， including 32 males （59.26%）and 40 children aged ≤ 3 months old （74.07%）， and 5 were vaccinated （9.26%）. The childrenweregrouped based on whether to exchange blood. The group comparison results showed that the exchange group had a faster heart rate （P=0.036）， concomitant pulmonary hypertension （P=0.006）， concomitant tricuspid regurgitation （P=0.002）， mechanical ventilation （P=0.014）， increased proportion of vasoactive drugs used （P<0.001）， and elevated activated prothrombin time （P=0.014） andblood creatinine （P=0.004）. The patients were grouped based on whether or not tracheal intubation was performed， and the inter-group comparison results showed that the proportion of vaccination decreased （P=0.021）， heart rate increased （P=0.008）， the patients hadconcomitant tricuspid regurgitation （P=0.035） and blood exchange （P=0.004）， and the proportion of using vasoactive drugs （P<0.001） increased in the invasive mechanical ventilation group;hemoglobin （P=0.021） and albumin decreased （P=0.004）， while CRP （P=0.004） and blood creatinine （P=0.017） increased. The K-M survival curve showed that the survival rates of children in white blood cells ≥ 36.0×109/L group （P=0.012）， lymphocytes ≥ 22.49×109/L group （P=0.012）， combined withpulmonary hypertension （P=0.003）， and combined withtricuspid regurgitation group （P<0.001） decreased. The result of the multivariate Cox regression model analysis indicated that white blood cell （HR=1.045， 95%CI：1.001-1.092， P=0.046） was an independent risk factor affecting the prognosis of children with severe pertussis. The higher the white blood cell， the worse the prognosis. Conclusion    When children with severe pertussis have white blood cells ≥36.0×109/L， lymphocytes ≥ 22.49×109/L， andare with pulmonary hypertension and tricuspid regurgitation， the survival rate decreases， and more active treatments are needed. Elevatedwhite blood cellis an independent risk factor affecting the prognosis of severe pertussis in children.

Key words: severe pertussis, child, pulmonary hypertension, elevated white blood cells