多重感染致儿童急性腹泻病的多中心临床研究  

Clinical analysis on coinfection in acute gastroenteritis of children

作　　者：张勇[1] 张紫荆 周少明[3] 肖力[4] 张秀琴[5] 朱忠生[3] 黄永生[5] 马战英[1] 邹明艳[1] 彭倩[1] 曾岳新 

机构地区：[1]东莞市妇幼保健院,523000 [2]广州市妇女儿童医疗中心,510120 [3]深圳市儿童医院,518038 [4]佛山市妇幼保健院,528200 [5]惠州市中心人民医院,516001

出　　处：《国际儿科学杂志》2017年第8期570-573,共4页International Journal of Pediatrics

摘　　要：目的观察急性腹泻患儿中单一感染与混合感染的发病率，比较单一和多个病原体感染患儿的临床表现。方法采用回顾性研究方法，选择年龄1个月～14岁诊断急性腹泻病的患儿4 728例作为观察对象。单一感染组和混合感染组患儿均进行大便常见病原体检测，包括轮状病毒（rotavirus，RV）、肠道腺病毒（enteric adenovirus，EAdV）、诺如病毒（norovirus，NV）抗原以及常见肠道致病菌的培养、分离鉴定。同时观察患儿病情的严重程度，包括腹泻持续时间和频率，发热、呕吐持续时间以及脱水的程度。结果4 728例患儿中有一种及一种以上病原体感染的有3 595例（76.0%），实验室检测未发现病原体感染的患儿有1 133例（24.0%）。其中RV感染有1 889例（40.0%），EAdV有412例（8.7%），NV感染有309例（6.5%），大肠埃希菌（VTEC）274例（5.8%），沙门菌属276例（5.8%），肺炎克雷伯菌感染123例（2.6%），志贺菌78例（1.6%），金黄色葡萄球菌70例（1.5%）和产气荚膜杆菌126例（2.7%）。其中1370例（29.0%）腹泻患儿存在混合感染，以RV合并NV感染150例（3.2%）及RV与产气荚膜菌混合感染127例（2.7%）为最常见。混合感染所致的儿童急性腹泻较单一感染临床表现更加严重，差异有统计学意义（P〈0.05）。结论轮状病毒仍是儿童急性腹泻最常见的病原体，其次为NV、EAdV、沙门菌属及VTEC。混合感染中轮状病毒合并诺如病毒感染最常见。在病毒与细菌混合感染时，VTEC与各类病毒合并感染发生率最高。多种病毒感染与单一病毒感染腹泻患儿比较，呕吐持续时间和脱水程度较严重，而发热及腹泻持续时间、腹泻频率则无明显差异。病毒合并细菌感染与单一病毒感染和单一细菌感染腹泻患儿的临床表现比较，混合感染患儿发热、呕吐及腹泻持续时间长，腹泻、脱水程度都更加严重。Objective To investigate the incidence of enteric pathogens causing acute gastroenteritis （AGE） among children to measure the incidence of coinfections, and to compare the clinical characteristics of those infected with one versus multiple agents. Methods A retrospective study was conducted from January 2014 to December 2014. All patients between 1 month and 14 years of age admitted to the Pediatric department with a diagnosis of AGE were eligible for enrollment. Two stool samples for each patient were tested for gastro- intestinal pathogens. We summarized the clinical severity of episodes, describing the duration of diarrhea, duration and frequency of vomiting, fever. All patients underwent medical evaluation with estimation of dehydration. Results One or more etiological agents were detected in 3595 out of 4728 patients（76.0% ）, while we did not detect any etiological agent in 1133 （24. 0% ）. Rotavirus was detected in 1889（40.0% ）, adenovirus in 412 （ 8.7 % ）, norovirus in 309 （ 6. 5 % ）, verotoxigenic Escherichia coli （VTEC） in 274 （ 5.8 % ）, Salmonella spp. in 276（5.8% ）, Klebsiella pneumoniae in 123 （2. 6% ）, Shigella spp. in 78 （ 1.6% ）, Staphylococcus aureus in 70 （ 1.5 % ）, C. perfringens in 126 （ 2. 7 % ）. In 1370 children out of 4728 （ 29.0% ）, we found evidence of coinfection. with rotavirus and norovirus was the most common 150 （ 3.2% ）, rotavirus and C. perfringens was also common 127（2. 7% ）. Children with coinfection had a more severe clinical presentation. The difference has statistical significance. Conclusion Rotavirus is still the most common pathogen in children with acute diarrhea, followed by NV, adenovirus, Salmonella spp. and VTEC. Rotavirus with norovirus infection was the most common. VTEC combined with three kinds of virus infection had the highest incidence. Children with multiple viral infections were more severe than those of single virus infection in the duration of vomiting and dehydration. There was no significant dif

关 键 词：腹泻病 病原体 混合感染 

分 类 号：R725.7[医药卫生—儿科]