基于准确病原的儿童大叶性肺炎炎症特点  

Inflammatory characteristics of lobar pneumonia in children with exact pathogens

作　　者：谢心怡 张阿敏 郑文宇 宁浩南 闫宪康 马辰晖 李福海[1] XIE Xinyi;ZHANG Amin;ZHENG Wenyu;NING Haonan;YAN Xiankang;MA Chenhui;LI Fuhai(Department of Pediatrics,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China;Cheeloo College of Medicine,Shandong University,Jinan 250012,Shandong,China)

机构地区：[1]山东大学齐鲁医院儿科,山东济南250012 [2]山东大学齐鲁医学院,山东济南250012

出　　处：《山东大学学报（医学版）》2022年第12期52-57,共6页Journal of Shandong University:Health Sciences

基　　金：山东省自然科学基金(ZR2020QH116)

摘　　要：目的 基于准确病原探讨儿童大叶性肺炎炎症特点。方法 回顾性分析2021年6月至12月于山东大学齐鲁医院儿科住院的153例大叶性肺炎患儿临床资料。按照肺泡灌洗液(BALF)宏基因组二代测序(mNGS)检测结果将患儿分为两组:单一感染组为单纯肺炎支原体(MP)感染(n=52)、混合感染组为肺炎链球菌(SP)与MP混合感染(n=26)。结果 133例患儿BALF中检出MP(86.9%)。单一感染组中性粒细胞、中性粒细胞/淋巴细胞比值均显著高于混合感染组(Z=-2.411,P=0.016;Z=-2.025,P=0.043)。两组发病8 d前白细胞均显著低于8 d后(Z=-2.399,P=0.016;Z=-2.109,P=0.035)。BALF细胞分类以中性粒细胞为主。单一感染组发病8 d前后BALF中中性粒细胞与巨噬细胞差异无统计学意义(t=1.334,P=0.190;t=-0.082,P=0.935)。混合感染组发病8 d前BALF中中性粒细胞显著高于8 d后、巨噬细胞显著低于8 d后(t=2.707,P=0.025;t=-6.087,P<0.001)。结论 儿童大叶性肺炎多为混合感染,常见病原体为MP和SP,局部与全身炎症反应强烈,易于出现难治病例。Objective To explore the inflammatory characteristics of lobar pneumonia in children based on accurate etiology. Methods The clinical data of 153 children with lobar pneumonia hospitalized in the Department of Pediatrics, Qilu Hospital of Shandong University during June 2021 and December 2021 were retrospectively analyzed. According to the detection results of metagenomic next-generation sequencing(mNGS) of the bronchoalveolar lavage fluid(BALF), the single infection group was infected with mycoplasma pneumoniae(MP)(n=52), and the mixed infection group was infected with streptococcus pneumoniae(SP) and MP(n=26). Results MP was detected in the BALF of 133 cases(86.9%). The neutrophil and neutrophil to lymphocyte ratio in the single infection group were significantly higher than those in the mixed infection group(Z=-2.411, P=0.016;Z=-2.025, P=0.043). The number of leukocytes in the two groups 8 days before the onset of disease was significantly lower than that 8 days after the onset(Z=-2.399, P=0.016;Z=-2.109, P=0.035). The cells in BALF were mainly neutrophils. There was no significance in the numbers of neutrophils and macrophages 8 days before and after the onset of disease in the single infection group(t=1.334, P=0.190;t=-0.082, P=0.935). In the mixed infection group, the number of neutrophils 8 days before onset was significantly higher than that 8 days after onset, while the number of macrophages was significantly lower(t=2.707, P=0.025;t=-6.087, P<0.001). Conclusion Lobar pneumonia in children is mostly mixed infection caused by MP and SP, with strong local and systemic inflammatory response. There are frequently refractory cases.

关 键 词：大叶性肺炎 肺炎支原体 肺炎链球菌 免疫调控 儿童 

分 类 号：R725.6[医药卫生—儿科]