天津地区儿童感染呼吸道病原菌组成及其临床特征  

Analysis of bacterial pathogens and clinical characteristics of children with respiratory tract infections in Tianjin

作　　者：王维[1] 张同强[2] 侯梦珠 宁爽 尚滢 王学韬 王露 林书祥[1] 方玉莲[1] 黄金月[1] 武晋英 张碧丽[4] 徐勇胜[2] Wang Wei;Zhang Tongqiang;Hou Mengzhu;Ning Shuang;Shang Ying;Wang Xuetao;Wang Lu;Lin Shuxiang;Fang Yulian;Huang Jinyue;Wu Jinying;Zhang Bili;Xu Yongsheng(Tianjin Key Laboratory of Birth Defects Prevention and Treatment,Tianjin Children′s Hospital,Tianjin Pediatric Research Institute,Tianjin 300134,China;Department of Respiratory Medicine,Tianjin Children′s Hospital,Tianjin 300134,China;Department of Pediatric Intensive Care Unit,Tianjin Children′s Hospital,Tianjin 300134,China;Special Care Ward,Tianjin Children′s Hospital,Tianjin 300134,China)

机构地区：[1]天津市儿童医院,天津市儿科研究所,天津市儿童出生缺陷防治重点实验室,300134 [2]天津市儿童医院呼吸科,300134 [3]天津市儿童医院重症监护科,300134 [4]天津市儿童医院特需病房,300134

出　　处：《中华儿科杂志》2021年第11期949-956,共8页Chinese Journal of Pediatrics

基　　金：国家自然科学基金(81772259);天津市重大疾病防治科技重大专项(18ZXDBSY00170);天津市科技计划项目(20JCZXJC00170)。

摘　　要：目的分析天津地区儿童感染呼吸道病原菌组成及其流行病学特点。方法回顾性病例分析,以2018年6月至2019年5月天津市儿童医院呼吸科、重症监护科及特需病房2392例住院患儿为研究对象,采用环介导等温扩增技术检测深部痰液、支气管肺泡灌洗液标本中的13种病原菌,观察不同性别、年龄、季节变化急性呼吸道感染患儿病原菌感染分布,按标本类型分为肺泡灌洗液组和深部痰液组。按患儿感染情况分为单一感染组和混合感染组(2种及以上病原菌感染)。对感染患儿实验室数据和临床特征进行分析,组间比较分别采用t检验或χ^(2)检验。结果2392例患儿中男1407例、女985例,男、女检出率差异无统计学意义[72.5%(1020/1407)比74.2%(731/985),χ^(2)=0.87,P=0.35]。共检出1751株12种阳性呼吸道病原菌,检出率为73.2%。其中913株(38.2%)肺炎支原体、514株(21.5%)肺炎链球菌、381株(15.9%)耐甲氧西林金黄色葡萄球菌、279株(11.7%)流感嗜血杆菌,未检出嗜肺军团菌。所有病原菌感染的四季检出率差异有统计学意义(χ^(2)=83.67,P<0.01)。肺泡灌洗液组阳性检出率高于深部痰液组[81.6%(614/752)比69.3%(1137/1640),χ^(2)=39.89,P<0.01]。不同病原菌感染的患儿住院时长、感染的发热时长、除乳酸脱氢酶外的其他实验室指标差异均有统计学意义(均P<0.01)。不同病原菌感染患儿患肺炎、支气管肺炎、哮喘、类百日咳综合征、鼻炎或鼻窦炎及其他上呼吸道感染比例差异有统计学意义(χ^(2)=228.69、103.56、3.96、27.38、24.50、41.66,均P<0.05)。肺炎支原体患儿出现肺不张(63例,7.7%)、胸膜炎(260例,31.9%)和胸腔积液(120例,14.7%)等影像学改变较多。嗜麦芽窄食单胞菌患儿最容易累及心脏系统(2/9),大肠埃希菌感染患儿出现血液(3/19),泌尿(2/19),消化(4/19)和全身炎症反应综合征、脓毒症(1/19)并发症的发生概率较高。结论天津地区儿童感染Objective To analyze the pathogenic bacteria and epidemiological characteristics in children with respiratory tract infection in Tianjin area.Methods Retrospective case analysis was performed on 2392 hospitalized children in the wards of respiratory diseases,intensive care unit and special care ward of Tianjin Children′s Hospital from June 2018 to May 2019.Thirteen pathogenic bacteria in deep sputum and bronchoalveolar lavage fluid samples were detected by loop-mediated isothermal amplification.The laboratory data and clinical characteristics of the infected children were analyzed,and the comparison between groups was performed by t test orχ2 test.Results Among 2392 cases,1407 were males and 985 females.There was no significant difference in the detection rate between males and females(72.5%(1020/1407)vs.74.2%(731/985),χ2=0.87,P=0.35).A total of 1751 strains and 12 kinds of positive respiratory pathogens were detected,with a detection rate of 73.2%.Among them,913(38.2%)strains were Mycoplasma pneumoniae(MP),514(21.5%)were Streptococcus pneumoniae(Sp),381(15.9%)were Methicillin-resistant Staphylococcus aureus(MRSA)and 279(11.7%)were Hemophilus influenzae(Hi).There was significant difference in the detection rate of pathogens among different age groups(χ^(2)=83.67,P<0.01).The positive rate of alveolar lavage fluid group was higher than that of deep sputum fluid group[81.6%(614/752)vs.69.3%(1137/1640),χ2=39.89,P<0.01].The length of hospital stay of children infected with different pathogens was significantly different(all P<0.01).There was significant difference in duration of fever among children infected with different pathogens(χ^(2)=228.69,103.56,3.96,27.38,24.50,41.66,all P<0.05).There were 63(7.7%)cases of atelectasis,260(31.9%)cases of pleurisy and 120(14.7%)cases of pleural effusion in MP children.Children with Sma were most likely to involve the heart system(2/9),and children with Eco infection had a higher incidence of complications such as those of blood(3/19),urinary(2/19),digestive systems(4/19),

关 键 词：儿童 呼吸道感染 流行病学 诊断 

分 类 号：R725.6[医药卫生—儿科] R446.5[医药卫生—临床医学]