2012至2017年1138例儿童侵袭性肺炎链球菌病多中心临床研究  

A multicenter clinical study on 1138cases of invasive pneumococcal disease in children from 2012 to 2017

作　　者：朱亮[1] 李文辉[3] 王新红 谭锟 方庆丰 朱庆雄[7] 武抗抗 杨巧芝[9] 林爱伟[10] 邓慧玲[11] 毕晶[13] 刘静[14] 赵仕勇 刘耘 景淑军[17] 王育民 李莲梅 赵青[20] 姚开虎[2] 王曦 贾莉[3] 王芳[4] 邓继岿[21] 孙静[6] 朱春晖[7] 周凯[8] 梁珺[9] 聂秀真[10] 曹三成[12] 王冬萌[13] 李双杰[14] 陈雪夏 李娟 王屹[17] 叶岚 张艳虹 董芳[20] 李志[4] 杨永弘[2] 刘钢[1] Zhu Liang;Li Wenhui;Wang Xirthonga;Tan Kun;Fang Qingfeng;Zhu Qingxiong;Wu Kangkang;Yang Qiaozhi;Lin Aiwei;Deng Hulling;Bi Jing;Liu Jing;Zhao Shiyong;Liu Yun;Jing Shujun;Wang Yumin;Li Lianmei;Zhao Qing;Yao Kaihu;Wang Xi;Jia Li;Wang Fang;Deng Jikui;Sun ling;Zhu Chunhui;Zhou Kai;Liang Jun;Nie Xiuzhen;Cao Sancheng;Wang Dongmeng;Li Shuangjie;Chen Xuexia;Li Juan;Wang Yi;Ye Lan;Zhang Yanhong;Dong Fang;Li Zhi;Yang Yonghong;Liu Gang(Key Laboratory for Major Disease in Children,Ministry of Education,Department of Infectious Diseases,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Department of lnfectious Disease,Children's Hospital of Hebei Province,Shijiazhuang 050031,China;Department of Infectious Diseases,Children's Hospital Affiliated to Zhengzhou University,Children's Hospital of Henan Province,Zhengzhou 450053,China;Zunyi Medical University,Zunyi 563003,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院感染内科儿科重大疾病研究教育部重点实验室,100045 [10]济南市儿童医院感染科 [11]西安市儿童医院感染2科 [12]西安市儿童医院检验科 [13]保定市儿童医院感染内科 [14]湖南省儿童医院感染科 [15]杭州市儿童医院感染科 [16]乌鲁木齐儿童医院感染科 [17]大连市儿童医院感染科 [18]内蒙古妇幼保健院儿科 [19]青海省妇女儿童医院感染消化科 [2]北京市儿科研究所微生物研究室 [20]山西省儿童医院感染科 [21]深圳市儿童医院感染科 [3]河北省儿童医院感染科石家庄050031 [4]郑州大学附属儿童医院感染性疾病科,450053 [5]遵义医学院563003 [6]安徽医科大学附属省儿童医院感染科 [7]江西省儿童医院感染科 [8]南京医科大学附属儿童医院感染科 [9]山东省聊城市人民医院儿科

出　　处：《中华儿科杂志》2018年第12期915-922,共8页Chinese Journal of Pediatrics

基　　金：北京市医管局“登峰”人才计划(DFL20181201).

摘　　要：目的了解我国儿童侵袭性肺炎链球菌病(IPD)的临床特点及菌株分型、细菌耐药情况。方法本研究为多中心回顾性研究。通过检索2012--2017年18家儿童医院的细菌培养信息管理系统查找自无菌部位(血、脑脊液、胸腹水、关节积液等)分离出肺炎链球菌的住院患儿,收集患儿临床信息及菌株血清型和耐药性检测结果。将患儿按随访结果分为死亡组和好转组,多因素Logistics回归分析IPD死亡危险因素。结果共确定1138例IPD患儿,其中男684例、女454例,男女比例为1.5:1,年龄范围为1日龄~16岁,中位年龄为1岁3月龄,5岁以下1016例,占89.3%,尤其是2岁以下(704例,61.9%);社区感染者1004例(88.2%)。临床类型包括脑膜炎446例(39.2%)、菌血症性肺炎339例(29.8%)、无病灶血流感染232例(20.4%)等。患儿有基础疾病者242例(21.3%)。混合感染支原体62例(5.4%),腺病毒27例(2.4%),流感病毒34例(3.0%)。脑膜炎和非脑膜炎菌株对青霉素的不敏感率分别为69.5%(276/397)和35.9%(221/615)。81株确定了血清型,其中13价肺炎球菌蛋白多糖结合疫苗(PCVl3)覆盖血清型占93.8%(76/81)。预后随访965例,确定死亡156例,病死率16.2%。多因素Logistics回归分析表明<2岁[比值比(OR)=2.143,95%可信区间(c,)为1.284—3.577,P=0.004],脑膜炎(OR=3.066,95%CI为1.852~5.074,P<0.01),有基础病(OR=4.801,95%CI为2.953—7.804,P<O.01),感染性休克(OR=3.542,95%CI为1.829~6.859,P<0.01),弥漫性血管内凝血(OR=4.150,95%CI为1.468—11.733,P=0.007),多脏器衰竭(OR=12.693,95%CI为6.623—24.325,P<0.01)和中枢神经系统并发症(OR=1.975,95%CI为1.144~3.410,P=0.015)为患儿死亡的独立危险因素。结论我国儿科确诊的IPD多为5岁以下、有基础疾病的社区感染患儿,<2岁、脑膜炎、基础病及多脏器衰竭等是死亡的独立危险因素,IPD致病株耐药严重,推广接种PCVl3疫苗有助于我国儿童预防IPD。Objective To explore the clinical features,the serotype distribution and drug resistance of the isolates in patient with invasive pneumocoecal disease (IPD).Methods By retrieving the laboratory information system in 18children's hospitals from 2012to 2017,the children with IPD were enrolled.Streptococcus pneumoniae (Spn)must be isolated fiom the sterile sites (blood,cerebrospinal fluid, hydrothorax and joint effusion etc.).The clinical characteristics,serotype,drug resistance,treatment and prognosis were reviewed and analyzed.According to the telephone follow up results,the patients were divided into death group and recovered group.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.Results There were 1138children with IPD, including 684male and 454female.The proportion of male to female was 1.5:1.The age ranged from one day to 16years.The median age was 1year 3month.The majority was under 5years of age (89.3%,n= 1016),especially under 2years of age (61.9%,n=704).In all cases,88.2%(n=l 004)were community acquired infection.The infections included meningitis (n=446,39.2%),pneumonia with bacteremia (n=339, 29.8%),and bacteremia without focus (n=232,20.4%).Underlying diseases were found in 242cases (21.3%).Co-infections were determined in 62cases (5.4%)with mycoplasma,27cases (2.4%)with adenovirus and 34cases with influenza virus (3.0%).The penicillin insensitivity (PNSP)rates in meningitis and non-meningitis isolates were 69.5%(276/397)and 35.9%(221/615),respectively.There were 81strains serotyped,in which 93.8%(76/81)were covered by 13-valent protein-polysaecharide conjugate vaccine (PCV13).In the 965patients who were followed up by phone call,156cases (16.2%)were confirmed dead. The independent risk factors for the death were under 2years of age (0R=2.143,95%CI 1.284-3.577, P=0.004),meningitis (OR=3.066,95%CI 1.852-5.074,P<0.01),underlying disease (OR=4.801,95%CI 2.953-7.804,P<0.01),septic shock(OR=3.542,95%CI 1.829-6.859,P<0.01),disseminated intravas

关 键 词：肺炎球菌感染 多中心研究 儿童 

分 类 号：R725.6[医药卫生—儿科]