儿童甲型和乙型流感病毒肺炎临床特征和混合感染比较  

Comparison of clinical features and co-infection between pneumonia caused by influenza virus A and pneumonia caused by influenza virus B among children

作　　者：华军[1] 杜晓晨[1] 李莺[1] 谢敏慧[1] 张学兰[2] 丁云芳[2] 郝创利[3] 季伟[3] 

机构地区：[1]苏州大学附属儿童医院急救科,江苏苏州215003 [2]苏州大学附属儿童医院检验科,江苏苏州215003 [3]苏州大学附属儿童医院呼吸科,江苏苏州215003

出　　处：《中国当代儿科杂志》2013年第11期990-994,共5页Chinese Journal of Contemporary Pediatrics

摘　　要：目的比较儿童甲型和乙型流感病毒(IV)肺炎的临床表现和混合感染情况。方法选取165例IV肺炎患儿为研究对象,根据IV亚型分为甲型流感病毒肺炎(IVA,71例)和乙型流感病毒肺炎(IVB,94例)两组;再根据是否合并其他病原感染分为单纯感染IVA组(14例)、IVA混合感染组(57例)、单纯感染IVB组(27例)和IVB混合感染组(67例),分析儿童IV肺炎的混合感染率及病原菌分布情况。结果 IVB组的平均发病年龄和平均发热天数均显著大于IVA组(均P<0.05)。IV肺炎患儿的混合感染率为75.2%,细菌混合感染率为44.2%,肺炎支原体混合感染率为21.8%。IV肺炎合并其他病毒混合感染率为45.5%,其中89%为呼吸道合胞病毒(RSV)感染;IVA组RSV混合感染率显著高于IVB组(P<0.05)。除白细胞计数和肌酐水平外,年龄、住院天数、发热天数、中性粒细胞百分比、前白蛋白、C反应蛋白、谷丙转氨酶、肌酸激酶同功酶等临床指标在单纯IV肺炎组和IV混合感染组差异均无统计学意义。结论 IVB肺炎患儿发热时间更长且发病年龄更大;IV肺炎混合感染率高,呈细菌、病毒和肺炎支原体多病原混合感染;IVA更易合并RSV混合感染;临床指标大多不易区别是否存在混合感染。Objective To compare the clinical features and co-infection between pneumonia caused by influenza virus A （IVA） and pneumonia caused by influenza virus B （IVB） among children. Methods A total of 165 children with pneumonia caused by influenza virus （IV） were included in the study. These subjects were divided into IVA（n=71） and IVB pneumonia groups （n=94） according to the subtypes of IV. The IVA pneumonia group was further divided into simple infection （n=14） and co-infection subgroups （n=57）, and the IVB pneumonia group was also further divided into simple infection （n=27） and co-infection subgroups （n=67）. Co-infection rate and pathogen spectrum were analysed in children with IV pneumonia. Results The IVB pneumonia group had significantly increased mean age of onset and significantly prolonged mean duration of fever compared with the IVA pneumonia group （P〈0.05）. Co-infection rate among children with IV pneumonia was 75.2%, who were co-infected with bacteria （44.2%）, Mycoplasma pneumoniae （MP, 21.8%） and other viruses （45.5%）. Respiratory syncytial virus （RSV） was most common in children coqnfected viruses （89%）. The rate of co-infection with RSV was significantly higher in the IVA pneumonia group than in the IVB pneumonia group. There were no significant differences in age, length of hospital stay, duration of fever, percentage of neutrophils, prealbumin, C-reactive protein, alanine aminotransferase, and creatine kinase-MB between the simple infection and co-infection subgroups of each group. Conclusions Children with IVB pneumonia have prolonged duration of fever and increased age of onset compared with those with IVA pneumonia. Co-infection rate is high among children with IV pneumonia, who may be co-infected with bacteria, viruses and MP. Co-infection with RSV is more common in children with IVA pneumonia. It is difficult to identify the presense of co-infection using clinical indices.

关 键 词：流感病毒 肺炎 混合感染 儿童 

分 类 号：R725.6[医药卫生—儿科]