儿童气源性和血源性金黄色葡萄球菌肺炎临床及影像学特点分析  

Analysis of clinical and imaging features of air-borne and blood-borne Staphylococcus aureus pneumonia in children

作　　者：薛晓瑞 吴丽娜[3] 王丽杰[1] Xue Xiaorui;Wu Lina;Wang Lijie(Department of Pediatric Intensive Care Unit,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Respiratory,Children′s Hosital of Soochow University,Suzhou 215002,China;Department of Clinical Laboratory,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿重症监护病房,沈阳110004 [2]苏州大学附属儿童医院呼吸科,215002 [3]中国医科大学附属盛京医院检验科,沈阳110004

出　　处：《中国小儿急救医学》2023年第11期845-849,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的比较气源性和血源性儿童金黄色葡萄球菌肺炎(SAP)的临床及影像学表现。方法回顾性分析中国医科大学附属盛京医院2015至2020年收治的54例儿童SAP病例的临床资料,其中气源性感染组28例,血源性感染组26例。比较两组患儿的一般资料、临床表现、实验室检查结果和肺部影像学资料等。结果气源性感染组和血源性感染组年龄、性别、发病季节比较差异无统计学意义(P>0.05)。气源性感染组患儿咳嗽、呼吸困难和肺部啰音发生率显著高于血源性感染组(P<0.05)。气源性感染组常合并急性呼吸窘迫综合征和呼吸衰竭,肺外感染较少见。血源性感染组呼吸道症状和体征不明显,多合并其他部位或全身感染中毒症状,如脓毒性休克、皮肤软组织感染、骨髓炎等。血源性感染组白细胞降低(<4.0×10^(9)/L)较气源性感染组更多见。血源性感染组C-反应蛋白、降钙素原、白细胞介素-6的中位数均大于气源性感染组,但差异无统计学意义(P>0.05)。影像学上,气源性SAP肺部大片渗出和实变发生率更高,血源性SAP肺部结节影和肺气囊发生率更高(P<0.05)。结论气源性和血源性SAP临床和影像学表现各有差异。气源性SAP呼吸道症状较突出,血源性SAP全身中毒症状较重。影像学上,气源性SAP更容易出现肺部大片实变,血源性SAP更容易出现肺部结节影和肺气囊。Objective To compare the clinical and imaging features of air-borne and blood-borne Staphylococcus aureus pneumonia(SAP)in children.Methods The clinical data of 54 children with SAP from 2015 to 2020 at Shengjing Hospital of China Medical University were retrospectively analyzed,including 28 cases in air-borne group and 26 cases in blood-borne group.The general data,clinical manifestations,laboratory tests and imaging data of the patients in two groups were compared.Results There were no significant differences in age,sex and onset season between air-borne group and blood-borne group(P>0.05).The incidences of cough,dyspnea and lung rale in air-borne group were significantly higher than those in blood-borne group(P<0.05).Air-borne group was often complicated with acute respiratory distress syndrome and respiratory failure,but extrapulmonary infection was rare.The symptoms and signs of respiratory tract in patients from the blood-borne group were not obvious,and more complicated with other parts or systemic infection and poisoning symptoms,such as septic shock,skin and soft tissue infection,osteomyelitis,etc.The patients with leukocyte decrease(<4.0×10^(9)/L)in blood-borne group were more than those patients from air-borne group.The median values of C-reactive protein,procalcitonin and interleukin-6 in blood-borne group were higher than those in air-borne group,but there were no statistical differences(P>0.05).On imaging,the incidences of massive pulmonary exudation and consolidation in air-borne SAP were higher,while the incidences of pulmonary nodules and air sacs in blood-borne SAP were higher(P<0.05).Conclusion The clinical and imaging manifestations of air-borne SAP and blood-borne SAP are different.Respiratory symptoms of air-borne SAP are prominent,however,systemic poisoning symptoms of blood-borne SAP are severe.As for imaging,air-borne SAP is more prone to large lung consolidation,while blood-borne SAP is more prone to lung nodules and air bags.

关 键 词：肺炎 金黄色葡萄球菌 耐甲氧西林金黄色葡萄球菌 影像学 儿童 

分 类 号：R725.6[医药卫生—儿科]