58例儿童胸腔积液的病因和临床特征  

Analysis of the etiology and clinical features of 58 children with pleural effusion

作　　者：张蘅辞 邹培远 朱晓萍[1,2] ZHANG Hengci;ZOU Peiyuan;ZHU Xiaoping(School of Pediatrics,Guizhou Medical University,Guiyang 550025,Guizhou,China;Respiratory Department of Pediatrics,the Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学儿科学院,贵州贵阳550025 [2]贵州医科大学附属医院儿科呼吸,贵州贵阳550004

出　　处：《贵州医科大学学报》2021年第8期937-942,共6页Journal of Guizhou Medical University

基　　金：贵州省科技厅社会发展攻关项目[黔科合支撑(2020)4Y124]。

摘　　要：目的探讨儿童胸腔积液(PE)的病因和临床特征。方法选取PE患儿58例,收集患儿入院时的一般临床资料(年龄、性别、病程及临床表现);抽取患儿入院时PE 10 mL,取3 mL采用电阻抗凝法检测总细胞数、白细胞数,取3 mL采用分光光度免疫法检测总蛋白、腺苷脱氨酶(ADA)及乳酸脱氢酶(LDH),取4 mL采用羟基乙酸酯培养基行胸水细菌培养;抽取患儿入院时空腹静脉血8 mL,离心取血清4 mL,采用酶联免疫吸附测定法(ELISA)、间接免疫荧光法及被动凝集法分别检测血清Epstein-Barr病毒(EBV)、结核杆菌、沙门菌及肺炎支原体抗体;抽取疑似真菌感染患儿空腹静脉血,采用动态显色法和ELISA分别检测血清1,3-β-D葡聚糖(G试验)和半乳甘露聚糖(GM试验);抽取患儿入院时空腹静脉血4 mL,采用BDBACTEC^(TM) FX全自动微生物培养仪行血液细菌培养;取患儿入院时痰液6 mL,采用巧克力琼脂培养基和血琼脂平板行痰细菌培养、并痰液涂片显微镜镜检查真菌;采用胸部电子计算机断层扫描仪器(CT)、胸部X线平片及B超行患儿影像学检查积液量及积液部位与感染病原体的关系。结果PE患儿以发热(60.3%)、咳嗽(56.9%)及呼吸困难(25.9%)为主要临床表现,临床体征主要以患侧呼吸音减弱(37.9%)为主;细菌感染患儿PE以细胞总数和白细胞总数增高为主(P<0.001),结核杆菌感染患儿PE以ADA增高为主(P=0.002);感染性PE以细菌性(肺炎链球菌)和肺炎支原体为主,<3岁PE儿童以细菌感染为主(P<0.05)、结核感染常见于>7岁儿童(P<0.05);细菌性、肺炎支原体性PE患儿以少量液体居多,非感染因素性PE患儿以中量液体为主,结核性PE患儿以大量液体为主。结论感染是导致PE患儿发病的主要原因,多见于肺炎链球菌及肺炎支原体感染;年龄较小PE患儿以细菌感染多见,年龄较大患儿以结核感染多见。Objective To explore the etiology and clinical features of children with pleural effusion(PE).Methods Fifty-eight children with PE were selected,and the general clinical data(age,gender,course of disease,and clinical manifestations)were collected;10 mL PE were extracted from the children when they were admitted to the hospital,3 mL of which were determined by resistance anticoagulation method for total cell count and white blood cell count,3 mL of which were determined by spectrophotometric immunoassay for total protein,adenosine deaminase(ADA),and lactate dehydrogenase(LDH),and 4 mL of which were cultured by pleural bacteria with hydroxy acetate medium;8 mL of fasting venous blood was extracted at admission,and 4 mL of serum was obtained through centrifuging;enzyme-linked immunosorbent assay(ELISA),indirect immunofluorescence,and passive agglutination methods were adopted to detect serum Epstein-Barr virus(EBV),Mycobacterium tuberculosis,Salmonella and Mycoplasma pneumoniae respectively;fasting venous blood was extracted from suspected fungal infection patients,and the dynamic colorimetric method and ELISA were adopted to detect 1,3-β-D glucan(G test)and galactomannan(GM test)respectively;4 mL of fasting venous blood were collected on hospital admission,and blood bacteria were cultured with BDBACTEC^(TM) FX automatic microbiological culture apparatus;6 mL of sputum were collected and cultured with chocolate agar medium and blood agar plate,and sputum smears were examined through the microscope for the fungus;chest computed tomography(CT),chest X-ray,and B-ultrasound were adopted to perform imaging examination for effusion volume and the relationship between effusion location with infection pathogens.Results The main clinical manifestations of PE children were fever(60.3%),cough(56.9%),and dyspnea(25.9%);the main clinical signs were decreased breath sound on the affected side(37.9%).The results of laboratory examination showed that the total cell count and white blood cell count in PE of children with bacterial

关 键 词：胸腔积液 感染 预后 儿童 病因 临床特点 

分 类 号：R725.6[医药卫生—儿科]