细菌和病毒混合感染对儿童社区获得性肺炎的影响  

Mixed infection of bacteria and viruses in community-acquired pneumonia in children

作　　者：王盈红[1] 曹小彩[1] 宋文涛[1] 李真珍[2] 

机构地区：[1]焦作市人民医院,河南焦作454002 [2]郑州大学第一附属医院重点实验室,河南郑州450052

出　　处：《临床儿科杂志》2016年第5期342-347,共6页Journal of Clinical Pediatrics

摘　　要：目的探讨细菌和病毒混合感染对儿童社区获得性肺炎(CAP)的影响。方法对204例CAP患儿行痰细菌、病毒、非典型病原体检测,有支气管镜检指征的患儿行支气管镜下肺泡灌洗(BALF),并进行定量培养和胞内菌检测。所有患儿给予抗菌药物序贯疗法治疗。结果 204例患儿中122例检出病原菌,检出率59.80%,检出病原菌153株,其中30例细菌和病毒混合感染。70例BALF菌培养,阳性8例,BALF标本可诱导共刺激分子(ICOS)阳性5例,以BALF定量培养作为对照,ICOS在CAP诊断中的灵敏度为37.50%,特异度为96.77%。30例细菌和病毒混合感染患儿中,<5岁27例(90.00%),其热程>10 d的比例高于非混合感染组,更容易发生胸腔积液,更易出现肺大片状阴影,白细胞水平、C反应蛋白、BALF中性粒细胞比例更高,中性粒细胞比值则较低,平均住院时间高于非混合感染组,差异均有统计学意义(P均<0.05)。所有患儿均好转出院。结论儿童CAP合并细菌和病毒混合感染可致热程和住院时间延长,合并症增加,影像学表现、实验室指标也与非混合感染患儿存在差异。Objective To explore the mixed infection of bacteria and viruses of community-acquired pneumonia (CAP) in children. Methods A total of 204 children with CAP were tested for sputum bacteria, viruses and atypical pathogen, and children with bronchoscope indications were performed with bronchoscope for alveolar lavage (BAL), and the BAL lfuid (BALF) was subjected to quantitative culture and intracellular bacteria detection. All the children were given antimicrobial sequential therapy. Results There were 153 strains of pathogenic bacteria isolated in 122 cases, the detection rate was 59.80%(122/204). Thirty cases were found with mixed bacterial and viral infections. BAL was performed on 70 cases, positive lavage germiculture were detected in 8 cases, of theses BALF specimen inducible co-stimulator (ICOS) positivity were found in 5 cases. Using BALF quantitative culture as control, the sensitivity of ICOS in the diagnosis of CAP was 37.50%and the speciifcity was 96.77%. In 30 cases of mixed infection with bacteria and viruses, 27 cases were younger than 5 years old, accounting for 90.00%. Duration of fever greater than 10 d in mixed infection group of children (43.33%, 13/30) was higher than that of the non-mixed infection group (23.12%, 40/173) (P?<?0.05), and patients in mixed infection group are more likely to have pleural effusion, and a large patch of shade on imaging. White blood cell levels, CRP and BALF neutrophil granulocyte ratio in mixed infection group were signiifcantly higher than that of non-mixed infection group (P?<?0.05), and the ratio of neutrophils is lower than that of the non-mixed infection group (P?<?0.05). After treatment, all the children were improved, and contents of CRP and IL-6 in both groups were lower than that prior to treatment (P?<?0.05), the comparison between groups showed no signiifcant difference (P?>?0.05). Average hospitalization time in children with mixed infection (13.5+1.5) d was higher than that with non-mixed infection (8.6+1.1) d (P?<?0.05). Conclusions Childhood CAP wit

关 键 词：混合感染 社区获得性肺炎 热程 支气管肺泡灌洗 儿童 

分 类 号：R725.6[医药卫生—儿科]