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

摘要： 目的    对儿童重症百日咳的临床特征进行分析，并探讨影响其预后的危险因素。方法    共纳入2023年8月至2024年2月期间于广州市妇女儿童医疗中心儿科重症监护病房（PICU）住院，确诊为重症百日咳的患儿54例。按是否换血、是否机械通气治疗对患儿进行分组，比较各组间患儿临床特征。采用Kaplan-Meier生存曲线及Log-rank检验比较不同白细胞及淋巴细胞水平、是否合并肺动脉高压及三尖瓣反流生存率的差异，采用单因素及多因素Cox回归方程法分析影响患儿预后的危险因素。结果    共纳入54例重症百日咳患儿，男性32例（59.26%），≤ 3月龄40例（74.07%），其中疫苗接种5例（9.26%）。按照是否换血分组，组间对比结果显示，换血组心率增快（P=0.036）、合并肺动脉高压（P=0.006）、合并三尖瓣反流（P=0.002）、机械通气（P=0.014）、应用血管活性药物比例升高（P<0.001），活化凝血酶原时间（P=0.014）、血肌酐升高（P=0.004）。按照是否气管插管分组，组间对比结果显示，有创机械通气组疫苗接种比例降低（P=0.021），心率增快（P=0.008）、合并三尖瓣反流（P=0.035）、换血（P=0.004）、应用血管活性药物（P<0.001）比例升高，血红蛋白（P=0.021）、白蛋白降低（P=0.004），CRP（P=0.004）、血肌酐（P=0.017）升高。K-M生存曲线显示，白细胞≥36.0×109/L组（P=0.012）、淋巴细胞≥ 22.49×109/L组（P=0.012）、合并肺动脉高压（P=0.003）、合并三尖瓣反流组（P<0.001）患儿生存率降低。多因素COX回归模型分析结果提示，白细胞（HR=1.045，95% CI：1.001~1.092，P=0.046）是影响重症百日咳患儿预后的独立危险因素，白细胞越高，预后越差。结论    儿童重症百日咳白细胞≥ 36.0×109/L、淋巴细胞≥ 22.49×109/L、合并肺动脉高压及三尖瓣反流时生存率下降，需积极治疗。白细胞升高是影响儿童重症百日咳预后的独立危险因素。

关键词: 重症百日咳, 儿童, 肺动脉高压, 白细胞升高