儿童社区获得性肺炎发病特点及导致重症的高危因素分析  

The characteristics of community-acquired pneumonia in children and the analysis of high-risk factors for severe pneumonia

作　　者：刘丽[1] 夏明月[1] 刘灵[1] 黄伟[1] 李明丽[1] LIU Li;XIA Ming-yue;LIU Ling;HUANG Wei;LI Ming-li(Department of Paediatrics,First Hospital of Qinhuangdao,Qinhuangdao 066600,Hebei,China)

机构地区：[1]秦皇岛市第一医院儿科,河北秦皇岛066600

出　　处：《川北医学院学报》2022年第12期1596-1599,1603,共5页Journal of North Sichuan Medical College

基　　金：河北省秦皇岛市科学技术研究与发展计划(202005A020)。

摘　　要：目的:探讨儿童社区获得性肺炎(CAP)发病特点及导致重症的高危因素。方法:选取480例儿童CAP患儿为研究对象,依据发病季节不同分为春季发病组(n=156)、夏季发病组(n=72)、秋季发病组(n=92)及冬季发病组(n=160)。比较4组患儿年龄分布(≤1岁、≤3岁、≤5岁及<15岁)、病原学特征(病毒:呼吸道合胞病毒、副流感病毒、流感病毒及腺病毒;细菌:肺炎链球菌、流感嗜血杆菌、黏膜炎莫拉菌、金黄色葡萄球菌、铜绿假单胞菌及其他;非典型微生物:肺炎支原体)及炎性因子[C-反应蛋白(CRP)、降钙素原(PCT)及白细胞(WBC)],分析影响CAP患儿症状程度的因素。结果:各组患儿年龄分布及不同年龄患儿病原学分布比较,差异无统计学意义(P>0.05)。冬季发病组患儿肺炎链球菌及流感嗜血杆菌检出率较其他3组更高(P<0.05);春季发病组患儿黏膜炎莫拉菌检出率较其他3组更高(P<0.05);其他病毒、细菌及非典型微生物检出率比较,差异无统计学意义(P>0.05)。各组患儿CRP、PCT及WBC水平比较,差异无统计学意义(P>0.05)。单因素分析结果显示,轻症患儿与重症患儿在性别、是否贫血、是否营养不良、是否有既往感染史、是否为早产、父母是否吸烟、是否有住院史、CRP、PCT及WBC水平等方面比较,差异均有统计学意义(P<0.05);回归分析结果显示,CRP、PCT、WBC、是否贫血、是否营养不良、是否有既往感染史、是否为早产、父母是否吸烟及是否有住院史为影响患儿症状程度的主要因素。结论:儿童CAP冬春季主要致病菌为肺炎链球菌、流感嗜血杆菌、黏膜炎莫拉菌;夏秋季肺炎支原体有上升趋势且部分合并细菌感染;儿童重症CAP主要病原体为肺炎支原体及肺炎链球菌,且机体内炎性因子水平较高;贫血、营养不良、有既往感染史、早产、有住院史及各炎性因子水平较高是导致CAP患儿出现重症的主要因素,临床需对该�Objective:To explore the characteristics of community-acquired pneumonia in children and the analysis of high-risk factors for severe pneumonia.Methods:480 children with CAP were selected as the research objects and divided into spring onset group(n=156),summer onset group(n=72),autumn onset group(n=92)and winter incidence group(n=160)according to different seasons.The age distribution(≤1 years old,≤3 years old,≤5 years old and<15 years old),etiological characteristics(viruses:respiratory syncytial virus,parainfluenza virus,influenza virus and adenovirus,bacteria:Streptococcus pneumoniae,Haemophilusinfluenzae,Moraxella catarrhalis,Staphylococcus aureus,Pseudomonas aeruginosa and others;atypical microorganisms:Mycoplasma pneumoniae)and inflammatory factors[C-reactive protein(CRP),procalcitonin(PCT)and white blood cells(WBC)]were compared between the four groups,and at the same time the factors influencing the symptom degree of children with CAP were analyzed.Results:There was no significant difference in the age distribution and etiological distribution of different ages of children among the groups(P>0.05).The detection rates of Streptococcus pneumoniae and Haemophilusinfluenzae in the winter-onset group were higher than those in the other three groups(P<0.05),and the detection rate of Moraxella catarrhalis in the spring onset group was higher than that in the other three groups(P<0.05),compared with the other three groups,the detection rate of other viruses,bacteria and atypical microorganisms had no significant difference(P>0.05).There was no significant difference in the levels of CRP,PCT and WBC among the groups(P>0.05).The results of univariate analysis showed that children with mild disease were significantly correlated with children with severe disease in terms of gender,anemia,malnutrition,history of previous infection,premature birth,smoking parents,history of hospitalization,CRP,PCT and WBC levels(P<0.05).The Logistic analysis showed that CRP,PCT,WBC,anemia,malnutrition,previous infection history,

关 键 词：儿童 社区获得性肺炎 发病特点 重症 影响因素 

分 类 号：R563.1[医药卫生—呼吸系统]