3月龄以下婴儿迁延性咳嗽百日咳感染状况调查  

Survey of pertussis infection in infants aged under 3 months with persistent cough

作　　者：米荣[1] 伏瑾[2] 康利民[1] 崔晓岱[2] 王晓颖[1] 李莉[1] 徐放生[1] 

机构地区：[1]首都儿科研究所附属儿童医院新生儿科,北京100020 [2]首都儿科研究所附属儿童医院中心实验室,北京100020

出　　处：《中华医学杂志》2012年第28期1974-1977,共4页National Medical Journal of China

摘　　要：目的调查3月龄以下（≤3个月）的住院患儿中迁延性咳嗽（咳嗽2周以上）婴儿博德特百日咳杆菌感染状况。方法对2011年1月至2012年1月首都儿科研究所附属儿童医院收治的3月龄以下迁延性咳嗽患儿采集血清和深部呼吸道分泌物，分别采用酶联免疫吸附实验及多重PCR方法检测博德特百日咳杆菌毒素抗体及博德特百日咳杆菌。结果人组患儿59例，男32例、女27例，均未接种白百破疫苗。多重PCR检测博德特百日咳杆菌阳性患儿17例（28．8％），3例年龄〈1个月，4例1—2个月，10例2～3个月；3例婴儿有家庭内慢性咳嗽患者的密切接触史，其家庭成员百日咳血清抗体阳性。百日咳杆菌阳性患儿中16例有阵发性痉挛性咳嗽，5例有吸气末鸡鸣样吼声，7例有结膜出血，10例有淋巴细胞升高为主的白细胞升高。结论未接种白百破疫苗、博德特百日咳杆菌感染是3月龄以下患儿迁延性咳嗽的重要致病因素；百日咳杆菌多重PCR检测快速、敏感，可用于临床早期诊断；未诊断的成人百日咳可能是婴儿的重要传染源。Objective To explore the prevalence of pertussis in hospitalized infants aged under 3 months with persistent cough. Methods The nasopharyngeal secretions and serum samples were collected from hospitalized infants aged under 3 months with cough for over 2 weeks from January 2011 to January 2012. The samples of nasopharyngeal secretion were suetioned and collected. Multiplex PCR assay was employed to identify Bordetella pertussis （B. pertussis ）and enzyme-linked immunosorbent assay used to detect antibody to pertussis toxin （PT-IgG）. Total bacterial DNA was exacted from nasopharyngeal secretion and two-target IS481/PT of B. pertussis was detected by PCR. Results Fifty-nine infants （ 32 boys and 27 girls） were enrolled. None of them was pre-immunized with diphtheria-pertussis-tetanus vaccine. Seventeen infants （28. 8% ） were B. Pertussis positive. Among 17 cases, 3 infants under 1 month, 4 infants 1 -2 months, and 10 infants 2 -3 months. Three infants had household contacts with persistent cough and their serum antibodies to pertussis toxin were positive. Sixteen infants with pertussis had the paroxysms of frequent and rapid coughs while another 5 with pertussis had long inspiratory effort accompanied by a high-pitched ＂whoop＂ at the end of paroxysms. Seven infants with pertussis had eonjunctiva bleeding, a special sign of pertussis. Ten infants had lymphocytosis with a predominant elevation of lymphocytes. Conclusions B. pertussis is an important pathogen for the infants under 3 months with persistent cough. Multiplex PCR may be used to identify B. pertussis with a high sensitivity. The unrecognized close family members of the infants with pertussis are probably an important source of infection.

关 键 词：博德特菌 百日咳 婴儿 聚合酶链反应 

分 类 号：R725.6[医药卫生—儿科]