小儿上呼吸道感染病原菌分析及血清炎症因子的辅助诊断价值  

Analysis of pathogenic bacteria in children with upper respiratory tract infections and the auxiliary diagnosis value of of serum inflammatory factors

作　　者：胡春芳 黄胜兰 王代宏 朱春玲[4] 吴俊 

机构地区：[1]咸宁市中心医院湖北科技学院附属第一医院检验科,湖北咸宁437100 [2]咸宁市妇幼保健院B超室,湖北咸宁437100 [3]咸宁市中心医院湖北科技学院附属第一医院肝胆外科,湖北咸宁437100 [4]咸宁市中心医院湖北科技学院附属第一医院药剂科,湖北咸宁437100 [5]嘉兴市南湖区中心医院内科,浙江嘉兴314005

出　　处：《中华医院感染学杂志》2017年第17期4008-4011,共4页Chinese Journal of Nosocomiology

基　　金：湖北省科学技术厅基金资助项目(2015CFB685)

摘　　要：目的分析小儿上呼吸道感染病原菌分布及血清炎症因子改变的意义,为临床诊疗提供参考。方法选择2015年6月-2016年6月在医院儿科接受就诊的小儿上呼吸道感染患儿87例作为观察组,另纳入健康对照组80例;使用吸痰器采集观察组患儿呼吸道分泌物进行病原菌鉴定;同时比较两组儿童的血清炎症因子水平,并使用ROC曲线分析相关指标对小儿上呼吸道感染的诊断价值。结果观察组患儿共分离致病菌109株,其中革兰阴性菌71株占65.14%,革兰阳性菌38株占34.86%,排名前5位的病原菌依次为流感嗜血杆菌、肺炎链球菌、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌;观察组患儿与对照组儿童血清炎症因子CRP(16.8±6.7VS5.6±3.2;t=13.59,P<0.01)、TNF-α(22.6±4.3VS 4.7±2.1;t=33.71,P<0.01)、PCT(0.38±0.13VS0.12±0.08;t=15.40,P<0.01)比较,差异均具有统计学意义;ROC曲线分析显示:以13.49ng/L为截点值,TNF-α诊断小儿上呼吸道感染的敏感性为90.00%,特异性为89.66%,曲线下面积为0.87,其结果优于PCT、CRP。结论革兰阴性菌是小儿上呼吸道感染的主要致病菌,并且测定CRP、PCT及TNF-α水平在小儿上呼吸道感染病情的诊断及评价方面具有一定的临床意义。OBJECTIVE To explore the pathogen distribution and significance of changes of serum inflammatory factors in children with upper respiratory tract infections,so as to provide references for clinical diagnosis and treatment.METHODS A total of 87 cases of children with upper respiratory tract infections treated in our hospital from Jun.2015 to Jun.2016 were enrolled in this study and set as observation group,and 80 cases of healthy children were enrolled as control group.The sputum aspirator was use to collect respiratory secretions of observation group for pathogen identification.At the same time,serum levels of inflammatory factors between the two groups of children were compared,and ROC curve analysis was used to analyze the values of relevant indicators in diagnosis of pediatric upper respiratory tract infections.RESULTS Totally 109 strains of pathogens were isolated from observation group,including 71（65.14%）strains of gram-negative bacteria and 38（34.86%）strains of gram-positive bacteria.The top 5 species of pathogens were Haemophilus influenza,Streptococcus pneumoniae,Escherichia coli,Staphylococcus aureus and Klebsiella pneumoniae.The results also revealed that the serum CRP（16.8±6.7 vs 5.6±3.2;t=13.59,P〈0.01）,TNF-α（22.6±4.3 vs 4.7±2.1;t=33.71,P〈0.01）and PCT（0.38±0.13 vs 0.12±0.08;t=15.40,P〈0.01）had significant differences between the observation group and the control group（P〈0.05）.ROC curve analysis showed that using 13.49 ng/L as cut-off point,the sensitivity of TNF-α for the diagnosis of upper respiratory tract infections in children was 90.00%,the specificity was 89.66%,and the AUC was 0.87,which were better than these of PCT and CRP.CONCLUSION The main pathogens of upper respiratory tract infections in children were gram-negative bacteria.The determination of CRP,PCT and TNF-αlevels has certain clinical significance in the diagnosis and evaluation of children with upper respiratory tract infections.

关 键 词：上呼吸道感染 病原菌分布 炎症因子 降钙素原 C-反应蛋白 

分 类 号：R378[医药卫生—病原生物学]