儿童大叶性肺炎支气管肺泡灌洗液病原学与耐药性及其危险因素  

Pathogens isolated from bronchoalveolar lavage fluid of children with lobar pneumonia,drug resistance and risk factors

作　　者：陈玲[1] 胡荆江[1] 覃军[1] CHEN Ling;HU Jing-jiang;QIN Jun(Jingzhou Hospital Affiliated to Yangtze University,Jingzhou,Hubei 434020,China)

机构地区：[1]长江大学附属荆州医院儿科,湖北荆州434020

出　　处：《中华医院感染学杂志》2024年第5期770-774,共5页Chinese Journal of Nosocomiology

基　　金：湖北省科学技术计划基金资助项目(2019CFB567)。

摘　　要：目的 分析儿童大叶性肺炎支气管肺泡灌洗液(BALF)病原学与耐药性及其危险因素。方法 选择2018年7月-2021年8月长江大学附属荆州医院收治的大叶性肺炎患儿200例为研究组,分析其BALF病原微生物与耐药性,依据肺炎严重程度指数分为轻度组、中度组和重度组;选择同期于医院治疗的除肺炎外的其他呼吸道感染患儿110例为对照组,检测外周血单个核细胞丝苏氨酸激酶(Akt)、核转录因子-κB(NF-κB)表达,并监测其血清白细胞计数、C-反应蛋白、白细胞介素(IL)-6、IL-1β和肿瘤坏死因子α水平变化。结果 研究组BALF共检出病原菌214株,以肺炎支原体(MP)为主,其次是肺炎链球菌(SP);分别对左氧氟沙星、青霉素耐药率最高。研究组年龄和体质量指数低于对照组,Akt、NF-κB及炎性因子表达较对照组高(P<0.05)。Akt、NF-κB是大叶性肺炎的危险因素,而年龄增加为保护因素(P<0.05)。研究组患儿中,重度组Akt、NF-κB和炎性因子表达均较轻、中度组升高;且中度组较轻度组升高(P<0.05)。结论 儿童大叶性肺炎感染病原学以MP为主,SP和腺病毒等为次,混合感染也占一定比例;且患儿呈现低龄化,Akt/NF-κB信号通路激活和炎性因子高表达状态与其病情进展关系密切。OBJECTIVE To analyze the distribution and drug resistance of pathogens isolated from bronchoalveolar lavage fluid(BALF)of the children with lobar pneumonia and observe the risk factors.METHODS A total of 200 children with lobar pneumonia who were treated in Jingzhou Hospital Affiliated to Yangtze University from Jul 2018 to Aug 2021 were assigned as the study group,the distribution and drug resistance of pathogenic microor-ganisms isolated from BALF were observed,the patients of the study group were divided into the mild group,the moderate group and the severe group according to the severity of pneumonia.Meanwhile,110 children who had other types of respiratory tract infections were chosen as the control group.The expression levels of serine-threo-nine kinase(Akt)and nuclear factor-κB(NF-κB)in peripheral blood mononuclear cells(PBMCs)were detected.The changes of levels of serum white blood cells(WBC),C-reactive protein(CRP),interleukin(IL)-6,IL-1βand tumor necrosis factor-αwere monitored.RESULTS Totally 214 strains of pathogens were isolated from BALF of the patients in the study group,Mycoplasma pneumoniae was the predominant species of pathogen,followed by Streptococcus pneumoniae;the drug resistance rates of the two species of pathogens were respectively highest to levofloxacin and penicillin.The age and body mass index of the study group were significantly lower than those of the control group,the expression levels of Akt,NF-κB and inflammatory factors of the study group were signifi-cantly higher than those of the control group(P<0.05).Akt and NF-κB were the risk factors for the lobar pneu-monia,while the age was the protective factor(P<0.05).Among the children of the study group,the expression levels of Akt,NF-κB and inflammatory factors of the severe group were significantly higher than those of the moderate group and the mild group,and the expression levels of the above indexes of the moderate group were significantly higher than those of the mild group(P<0.05).CONCLUSION M.pneumoniae is the predom

关 键 词：大叶性肺炎 感染病原谱 丝苏氨酸激酶 核转录因子-κB 炎性因子水平 耐药性 

分 类 号：R725[医药卫生—儿科]