进一步关注我国儿童肺炎链球菌性疾病的研究  

A profound study on pneumococcal diseases in children in China

作　　者：杨永弘[1,2] 申昆玲[2] 郑跃杰[1] Yang Yonghong;Shen Kunling;Zheng Yuejie(Department of Respiration,Shenzhen Children′s Hospital,Shenzhen 518000,Guangdong Province,China;National Clinical Research Center for Respiratory Diseases,Department of Respiratory,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]深圳市儿童医院呼吸科,广东深圳518000 [2]国家儿童医学中心,首都医科大学附属北京儿童医院呼吸科,国家呼吸系统疾病临床医学研究中心,北京100045

出　　处：《中华实用儿科临床杂志》2020年第7期481-484,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：肺炎链球菌感染既可导致严重的侵袭性疾病,如脑膜炎、脓毒症及肺炎等,也可导致更为常见的轻症感染,如鼻窦炎及中耳炎等。致病原肺炎链球菌常定植在人类鼻咽部,主要通过飞沫传播,婴儿和低龄儿童是主要的带菌者。据估计2015年全球有583万5岁以下儿童死亡,其中约29.4万由肺炎链球菌感染所致,另外有23300名儿童死于人类免疫缺陷病毒与肺炎链球菌共感染。发展中国家的肺炎链球菌患病率和死亡率高于工业化国家,大部分肺炎链球菌相关死亡发生于亚洲和非洲地区。在2006年以前,肺炎链球菌结合疫苗(PCV)尚未广泛纳入国家免疫计划,据报道,当时欧洲2岁以下婴儿的侵袭性肺炎链球菌性疾病(IPD)年平均发生率为44.4/10万,美国为167/10万。每年有70万~100万的2岁以下婴儿因肺炎链球菌性疾病死亡,这相当于该年龄组疫苗可预防疾病死亡人数的28%。近年来耐β内酰胺酶和大环内酯类抗生素的肺炎链球菌分离株不断增加。多重耐药现象普遍,增加了临床医师治疗肺炎链球菌感染的难度。在过去的30年里,中国儿科医师在肺炎链球菌及肺炎链球菌性疾病方面做了很多出色的研究。一部分研究是关于临床分离株,尤其是侵袭性疾病菌株的血清型、抗生素耐药及分子分型的多中心监测。对抗原及抗体测定在肺炎链球菌性疾病诊断中的价值进行了评估,还对死于肺炎儿童的肺组织切片进行了回顾性研究,证实了肺炎链球菌作为潜在致病原的重要作用。此外还发现,肺炎链球菌的血清型、抗生素耐药性及分子分型在中国不同时期、不同地区存在差异。近年来肺炎链球菌导致的重症肺炎并不少见,部分病情恶化出现脓胸、脓毒症甚至休克。肺炎链球菌感染还可导致溶血尿毒综合征等特殊疾病的发生。在本期专刊里,有来自多位专家关于上述内容的报道。当前所用的肺炎链球Pneumococcal infections can lead to serious invasive diseases such as meningitis,sepsis and pneumonia,as well as milder but more common illnesses like sinusitis and otitis media.The causative agent,Streptococcus pneumoniae,usually colonizes the human nasopharynx and is transmitted mainly through respiratory droplets.Infants and young children are the main reservoir of this organism.Of the estimated 5.83 million deaths among under 5 years old in the world in 2015,294000 were caused by pneumococcal infections,and 23300 were ascribed to coinfection of pneumococcal infections with human immunodeficiency virus.The prevalence and mortality rates of pneumococcal diseases are higher in developing countries than in industrialized countries,and most deaths occur in Africa and Asia.Before widespread introduction of pneumococcal conjugate vaccine(PCV)into national immunization programmes in 2006,the reported mean annual incidence of invasive pneumococcal disease(IPD)in children aged<2 years was 44.4/100000 per year in Europe and 167/100000 per year in the United States of America.Pneumococcal diseases caused 700000 to 1000000 deaths in children aged<2 years,accounting for 28%of the vaccine preventable diseases in this age group.The increasing number of pneumococcal isolates resistant toβ-lactam and macrolide antibiotics worldwide in recent years makes it more difficult for clinicians to treat this disease.Among excellent studies on pneumococcus and pneumococcal diseases conducted by Chinese pediatricians in the past 30 years,some were multi-center surveillance for the serotyping,antibiotic resistance and molecular typing of clinical isolates,especially of IPD strains.These studies have evaluated the effect of antigen and antibody measurement on diagnosis of pneumococcal diseases,and reviewed lung tissues of autopsy for the children died of pneumonia,verifying that pneumococcus was a potential pathogen.The serotyping,antibiotic resistance and molecular typing of isolates varied in different time periods and areas in China.Se

关 键 词：肺炎链球菌 侵袭性肺炎链球菌性疾病 预防 多糖蛋白结合疫苗 世界肺炎日 

分 类 号：R72[医药卫生—儿科]