新生儿感染性肺炎的呼吸道菌群及免疫状况分析  

Respiratory tract flora and immunity of neonates with infectious pneumonia

作　　者：朱兆奎 乔立兴[1] 谢佳丽 钱丽娟[1] ZHU Zhao-kui;QIAO Li-xing;XIE Jia-li;QIAN Li-juan(Zhongda Hospital Affiliated to Southeast University,Nanjing,Jiangsu 210000,China)

机构地区：[1]东南大学附属中大医院儿科

出　　处：《中华医院感染学杂志》2019年第21期3316-3321,共6页Chinese Journal of Nosocomiology

基　　金：江苏省科技基金资助项目(BK20151420)

摘　　要：目的探讨新生儿感染性肺炎的呼吸道菌群构成特征,分析不同感染情况患儿机体免疫情况。方法将2016年3月-2018年5月东南大学附属中大医院感染性肺炎的新生儿68例纳入研究组,根据患儿住院时临床肺部感染评分将其中32例纳入轻度组,36例纳入重度组,同期医院健康新生儿28例纳入对照组。检测新生儿痰液中目标条带菌数、丰富度、香农-威纳指数、NK细胞含量、各细胞亚群及维生素D、免疫球蛋白表达。结果68例感染性肺炎新生儿呼吸道细菌培养阳性率为60.29%(41/68),共检出菌株64株,检出率居前3位病原菌由高至低分别为鲍氏复合醋酸钙不动杆菌、肺炎克雷伯菌、阴沟肠杆菌;患儿插管1 d内、3~5 d条带数目、香农-威纳指数相比,差异无统计学意义;插管1~3 d,重度组条带数目、香农-威纳指数均小于轻度组,差异具有统计学意义(P<0.05);研究组总NK、CD3-CD56negCD16bright水平低于对照组,CD3-CD56dimCD16bright、CD3-CD56brightCD16neg/dim水平高于对照组,组间CD3-CD56dimCD16bright比较差异具有统计学意义(P<0.05),CD3-CD56brightCD16neg/dim比较,差异无统计学意义;研究组CD3+CD8+、CD3+/CD8+、IgG与对照组相比,差异无统计学意义;研究组CD3+、CD3+CD4+低于对照组,差异具有统计学意义(P<0.05)。结论新生儿感染性肺炎患儿致病菌主要以鲍氏复合醋酸钙不动杆菌为主,患儿普遍存在NK细胞数量及功能缺陷,其细胞免疫功能受不同程度抑制。OBJECTIVE To explore the distribution of respiratory tract flora in the neonates with infectious pneumonia and analyze the immunity of the neonates.METHODS From Mar 2016 to May 2018,totally 68 neonates who had hospital-associated infectious pneumonia were assigned a the study group and were divided into the mild group with 32 cases and the severe group with 36 cases according to the clinical pulmonary infection score during the hospital stay;meanwhile,28 healthy neonates were set as the control group.The bacterial colony counts in target strip of sputum,richness,Shannon-Wiener diversity index,content of NK cell,cell subsets,vitamin D and expression of immunoglobulins were detected.RESULTS The positive rate of culture of respiratory tract bacteria was 60.29%(41/68)in the 68 neonates with infectious pneumonia.A total of 64 strains of pathogens were isolated,among which Acinetobacter baumannii combined with Acinetobacter acetate,Klebsiella pneumoniae and Enterobacter cloacae ranked the top 3 species.There were no significant differences in the number of target strips and Shannon-Wiener diversity index within 1 day of intubation or in 3-5 days of intubation;the number of strips and Shannon-Wiener diversity index of the severe group were less than those of the mild group,and there were significant difference(P<0.05).The levels of total NK and CD3-CD56negCD16bright of the study group were lower than those of the control group;the levels of CD3-CD56dimCD16bright and CD3-CD56brightCD16neg/dim of the study group were higher than those of the control group,and there was significantly difference in the CD3-CD56dimCD16brightbetween tow groups(P<0.05),while there was no significantly difference in the CD3-CD56brightCD16neg/dim between tow groups.There were no significant differences in CD3+CD8+,CD3+/CD8+and IgG between the study group and the control group;the levels of CD3+and CD3+CD4+of the study group significantly were lower than those of the control group(P<0.05).CONCLUSION A.baumannii combined with A.acetate is dominant

关 键 词：新生儿 感染性肺炎 呼吸道 菌群 免疫功能 

分 类 号：R722.13[医药卫生—儿科]