传染性单核细胞增多症继发医院细菌感染患儿的临床特点及病原学分析  

Clinical and etiological characteristics of secondary nosocomial bacterial infections associated with infectious mononucleosis in children

作　　者：王涛[1] 华益民[1] 周开宇[1] 王晓琴[1] 石晓青[1] 罗秋红[1] 乔莉娜[1] 

机构地区：[1]四川大学华西第二医院儿童心血管科,出生缺陷与相关妇儿疾病教育部重点实验室,成都610041

出　　处：《中华实用儿科临床杂志》2017年第22期1717-1720,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的分析儿童传染性单核细胞增多症（IM）病程中继发医院细菌感染的临床特点及病原学特征。方法收集2015年1月至12月于四川大学华西第二医院住院诊治的IM患儿，按病程中是否继发细菌感染分为继发感染组和未继发感染组，分析其临床表现和病原学特征。结果共纳入IM患儿216例，其中未继发感染组177例（81．9％），继发感染组39例（18．1％）。未继发感染组患儿年龄为（4．7±3．2）岁，继发感染组为（7．0±3．8）岁，2组比较差异有统计学意义（t=3．066，P〈0．05）。继发感染组包括细菌感染性扁桃体炎17例，支气管肺炎11例，中耳炎5例，颈细菌性淋巴结炎3例，眼周蜂窝织炎2例，脓毒症1例，其中3例并鹅口疮。继发感染组细菌感染率显著高于同期医院感染发生率[18．1％（39／216例）比1．53％（644／41992例）]，差异有统计学意义（X^2=368．474，P〈0．01）。继发感染组患儿均使用抗生素有效，致病细菌以革兰阴性菌为主，与患儿入院时咽腭扁桃体定植菌检出菌种一致。212例（98．1％）IM患儿变异淋巴细胞升高，2组变异淋巴细胞构成比比较，差异无统计学意义（X^2=2．087，P〉0．05）。IM患儿入院时c反应蛋白（CRP）水平为（11．3±17．4）mg／L，继发感染组[（10．2±9．7）mg／L]和未继发感染组[（11．5±18．1）mg／L]比较差异无统计学意义（t=1．309，P〉0．05）。继发感染组患儿行细胞免疫检查，其急性期CD3^＋、CD4^＋、CD8^＋淋巴细胞分别为（0．8776±0．0318）、（0．0790±0．0325）、（0．6821±0．0535），与未继发感染组相比，CD3^＋淋巴细胞（t=12．652，P〈0．01）和CD8^＋淋巴细胞（t=-9．723，P〈0．01）比例显著升高，CD4^＋淋巴细胞比例显著降低（t=18．341，P〈0．01）。结论IM患儿在病程中易继发医院细菌感染，且以学龄期儿童多见。继发呼吸道感染�Objective To investigate the clinical manifestations and pathogenic characteristics of nosocomial bacterial infection in children with infectious mononucleosis （IM）. Methods A retrospective analysis was performed for IM children from January to December 2015 in West China Second University Hospital. According to whether there was the process of secondary bacterial infection, the patients were divided into the secondary infection group and the non - infection group. The clinical manifestations and pathogenic bacteria were analyzed. Results Two hundred and sixteen children with IM were enrolled,of whom,177 cases （81.9%） were in the non - infection group,and 39 cases （ 18.1% ） were in the secondary infection group. The patients in non - infection group were （4.7±3.2） years old,and the patients in secondary infection group were （ 7.0±3.8 ） years old, and the difference was statistically significant （t = 3. 066 ,P 〈 0.05 ）. The secondary infection group included bacterial tonsillitis in 17 cases ,bronchial pneumonia in 11 cases, otitis media in 5 cases, cervical bacterial lymphadenitis in 3 cases, periorbital cellulitis in 2 cases, and sepsis in 1 case. Meanwhile,3 cases of concomitant thrush were observed in the secondary infection group. The rate of nosoco- mial bacterial infection in IM children [ 18.1% （39/216 cases） ] was significantly higher than the incidence of nosoco- mial infection [ 1.53% （644/41 992 cases） ] in the same period, and the difference was statistically significant （X^2 = 368. 474 ,P 〈 0.01 ）. The patients with secondary bacterial infection were treated with antibiotics, and the pathogenic bacteria were mainly gram -negative bacteria, which was consistent with pharyngeal tonsil colonization bacteria on ad- mission. In 212 cases （98.1% ） with IM, variant lymphocytes increased, and there was no significant difference between 2 groups in the variation of lymphocyte composition （X^2 = 2. 087, P 〉 0.05 ）. C - reactive protein （CRP） level of IM c

关 键 词：传染性单核细胞增多症 医院感染 回顾性研究 儿童 

分 类 号：R725.1[医药卫生—儿科]