呼吸道合胞病毒感染毛细支气管炎患儿鼻咽部细菌类别与临床特征研究  

Clinical characteristics and nasopharyngeal bacteria profiles in children with respiratory syncytial virus bronchiolitis

作　　者：张佳 孙慧明[2] 李淑湘[3] 王婷 张军 高原 屈林林 何龙兵 郝创利[2] Zhang Jia;Sun Huiming;Li Shuxiang;Wang Ting;Zhang Jun;Gao Yuan;Qu Linlin;He Longbing;Hao Chuangli(Department of Pediatrics,Suqian First Hospital,Suqian 223800,China;Department of Respiratory Medicine,Children′s Hospital of Soochow University,Suzhou 215003,China;Department of Laboratory,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215003,China)

机构地区：[1]宿迁市第一人民医院儿科,宿迁223800 [2]苏州大学附属儿童医院呼吸科,苏州215003 [3]南京医科大学附属苏州医院检验科,苏州215003

出　　处：《中华实用儿科临床杂志》2022年第10期738-742,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(81900006);苏州市科教兴卫(KJXW2020025)。

摘　　要：目的探讨呼吸道合胞病毒(RSV)感染毛细支气管炎患儿鼻咽部潜在的致病菌(PPB)检出情况及不同类别PPB对病情影响。方法本研究为回顾性队列研究, 选取2017年1月1日至2019年12月31日因RSV感染毛细支气管炎入住苏州大学附属儿童医院呼吸科病房的患儿作为研究对象, 检测患儿鼻咽部分泌物病毒、肺炎支原体和细菌, 按照年龄分<3个月组、3~<6个月组、6个月~<1岁组和1~2岁组, 按照鼻咽部有无PPB及其类别分为RSV单独感染组、RSV+G+菌组、RSV+G-菌组和RSV+G+菌+G-菌组, 各组间RSV+PPB阳性率的比较采用χ2检验, 临床特征比较采用Mann-Whitney U检验。结果共280例患儿纳入本研究, 其中RSV+PPB组患儿113例, 占40.4%。检出率最高的细菌为肺炎链球菌。肺炎链球菌在各年龄组间检出率呈上升趋势, 各组间比较差异有统计学意义(χ2=12.609, P=0.005), 金黄色葡萄球菌在各年龄组间检出率呈下降趋势, 各组间比较差异有统计学意义(χ2=8.387, P=0.034)。与RSV单独感染组比较, RSV+G-菌组患儿住院时间长、发热比例高、气促比例高、吸氧比例高和血C反应蛋白水平高(均P<0.05)。与RSV单独感染组比较, RSV+G+菌组年龄大、发热比例高、中性粒细胞比例高、淋巴细胞比例低和血C反应蛋白水平高(均P<0.05)。结论约40%的RSV毛细支气管炎患儿鼻咽部可检出PPB, 鼻咽部合并PPB感染可能影响RSV感染的病情严重程度。Objective To explore the detection of potentially pathogenic bacteria(PPB)in the nasopharynx of children with respiratory syncytial virus(RSV)bronchiolitis and the influence of PPB types on disease severity.Methods In this retrospective cohort study,clinical data of patients hospitalized for RSV bronchiolitis at Department of Respiratory Medicine,Children′s Hospital of Soochow University between January 1,2017 and December 31,2019 were retrospectively analyzed.The virus,Mycoplasma pneumoniae and bacteria in nasopharyngeal secretion of children were detected.They were classified into<3 months group,3-<6 months group,6 months-<1 year group and 1-2 years group based on the age.In addition,they were further classified into RSV infection group,RSV+G+group,RSV+G-group and RSV+G++G-group based on detected PPB in the nasopharynx.Comparison of RSV+PPB frequency between groups was performed by Chi-squared test,clinical characteristics were compared by using Mann-Whitney U test.Results A total of 280 patients with RSV bronchiolitis were included in the study,involving 113 cases(40.4%)with PPB in the nasopharynx.The most-common detection bacterium was Streptococcus pneumoniae.The detection rate of Streptococcus pneumoniae increased with age(χ2=12.609,P=0.005),while that of Staphylococcus aureus decreased with age(χ2=8.387,P=0.034).Compared with RSV group,patients in RSV+G-group had a longer length of stay,higher rate of fever and shortness of breath,higher oxygen supplement and higher C-reactive protein(CRP)(all P<0.05).Compared with RSV group,patients in RSV+G+group were older,and they had higher rate of fever,higher percentage of neutrophil,lower percentage of lymphocyte and higher CRP(all P<0.05).Conclusions PPB in nasopharynx can be detected in about 40%of children hospitalized with RSV bronchiolitis,and nasopharynx complicated with PPB infection may affect the severity of RSV bronchiolitis.

关 键 词：呼吸道合胞病毒 毛细支气管炎 鼻咽部细菌 病情严重度 

分 类 号：R725.6[医药卫生—儿科]