不同年龄段儿童嗜肺军团菌肺炎临床特征的差异  

Clinical characteristics of Legionella pneumophila pneumonia in children of different ages

作　　者：廖嘉仪 张涛 

机构地区：[1]广州市越秀区儿童医院呼吸科,广东广州510115

出　　处：《广东医学》2018年第1期97-102,共6页Guangdong Medical Journal

基　　金：广东省医学科研基金项目(编号:B2014351);广州市越秀区科技计划项目(编号:2012-WS-002);广州市医药卫生科技项目(编号:2009-YB-177)

摘　　要：目的了解不同年龄段儿童嗜肺军团菌肺炎(LPP)的临床特征。方法收集确诊LPP的住院患儿165例,对其临床资料进行回顾性总结分析。将所有入选患儿按年龄段分为0岁~组43例、1岁~组59例、3岁~组45例、6~<18岁组18例。比较不同年龄段儿童LPP的主要临床表现、肺部体征、实验室检查[白细胞计数(WBC)、淋巴细胞计数(LYM)、中性粒细胞计数(GRA)、单核细胞计数(MON)、C反应蛋白(CRP)、血沉(ESR)、α-羟丁酸脱氢酶(α-HBDH)、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶MB型同工酶(CK-MB)、天冬氨酸氨基转移酶(AST)、钾离子(K+)、钠离子(Na+)]、胸片资料等方面的差异。结果湿咳发生率高于干咳(X^2=4.849,P=0.028);湿啰音发生率高于干啰音(X^2=108.252,P<0.001);0岁~组、1岁~组气促发生率均高于3岁~组、6~<18岁组(P<0.05);4组间发热持续时间、肺部啰音发生率、湿啰音发生率比较,差异均有统计学意义(P<0.001)。α-HBDH、LDH、CK、CK-MB升高率比较,四者之间差异有统计学意义(X^2=296.768,P<0.001),CK升高率高于CK-MB升高率(X^2=9.076,P<0.05);Na+水平紊乱发生率高于K+水平紊乱发生率(X^2=9.859,P=0.002)。4组间WBC计数比较,差异有统计学意义(X^2=3.551,P<0.05);4组间LYM比例比较,差异有统计学意义(X^2=18.378,P<0.001),其中0岁~组、1岁~组均高于3岁~组、6~<18岁组(均P<0.001);4组间GRA比例比较,差异有统计学意义(X^2=22.598,P<0.001);4组间α-HBDH和LDH分别比较,差异均有统计学意义(均P<0.05);4组间K+水平比较,差异有统计学意义(X^2=19.000,P<0.001),4组间K+水平紊乱发生率比较,差异有统计学意义(X^2=8.990,P<0.05)。结论不同年龄段儿童LPP临床特征不同,尤其是0岁~、1岁~与6~<18岁儿童之间差异更明显。Objective To investigate the clinical characteristics of Legionella pneumopbila pneumonia （LPP） in children of different ages. Methods The clinical data of 165 children with LPP hospitalized from July 2015 to June 2016 were collected and retrospectively analyzed. All the selected children were divided into 0 - 〈 1 year old group （43 ca- ses） , 1 - 〈3 years group （59 cases）, 3 - 〈6 years group （45 cases） and 6 - 〈 18 years old group （18 cases）. The main clinical manifestations, physical signs of lung, laboratory examination, including white blood cell （ WBC）, lympho- cyte （LYM） , neutrophil （ GRA）, monocyte （MON） , C reactive protein （ CRP）, erythrocyte sedimentation rate （ ESR）, cL - hydroxybutyrate dehydrogenase （ α- HBDH）, lactic dehydrogenase （ LDH）, creatine kinase （ CK）, creatine kinase MB isoenzyme （CK -MB）, aspartate transaminase （AST）, potassium ion （K＋ ）, sodium ion （Na ＋ ）, and chest film were compared among different age groups. Results The incidence of wet cough was significantly higher than that of dry cough （ Z2 = 4. 849, P = 0. 028 ）, and the incidence of wet rales was significantly higher than that of dry tales （ Z2 = 108. 252, P 〈0. 001 ）. The incidences of shortness of breath in 0 - 〈 1 year old group and 1 - 〈3 years group were sig- nificantlv higher than those in 3 - 〈 6 vears awoun and 6 - 〈 18 years old groun （P 〈 0. 05 ）. There were significant differ-ences among the four groups in the duration of fever, the incidence of pulmonary rale and wet rales （ all P 〈 0. 001 ）, and the increased ratios of c~ - HBDH, LDIt, CK and CK - MB （ X^2 = 296. 768, P 〈 0. 001 ）. The increased ratio of CK was significantly higher than that of CK - MB （ X^2 = 9. 076, P 〈 0. 05 ）, and the incidence of abnormal Na ＋ level was signifi- cantly higher than that of abnormal K ＋ level （ Z2 = 9. 859, P = 0. 002 ）. There were significant differences among the four groups in WBC count （

关 键 词：嗜肺军团菌 肺炎 临床特征 儿童 

分 类 号：R725.6[医药卫生—儿科]