幼儿园儿童肺炎链球菌持续携带及影响因素分析  

Persistent carriage of Streptococcus pneumoniae and its influencing factors among children in kindergartens

作　　者：杨诗敏 邓文君 张景锋 李平原 周俊立 姚振江 叶小华 YANG Shimin;DENG Wenjun;ZHANG Jingfeng;LI Pingyuan;ZHOU Junli;YAO Zhenjiang;YE Xiaohua(Department of Epidemiology and Health Statistics,School of Public Health,Guangdong Pharmaceutical University,Guangzhou 510310,China)

机构地区：[1]广东药科大学公共卫生学院流行病与卫生统计学系,广州510310

出　　处：《中华疾病控制杂志》2024年第5期613-620,共8页Chinese Journal of Disease Control & Prevention

基　　金：国家自然科学基金(81973069);广东省基础与应用基础研究基金(2023A1515011583,2019A1515010915);广东省教育厅重点专项(2022ZDZX2033)。

摘　　要：目的探索幼儿园儿童肺炎链球菌的持续携带状况及其影响因素。方法采用多阶段分层整群抽样方法,抽取佛山市顺德区6所幼儿园的健康儿童,对所有儿童进行3次鼻拭子采样并分离鉴定肺炎链球菌。采用单因素χ^(2)检验和多因素logistic回归分析模型分析儿童肺炎链球菌持续携带的影响因素。鉴于3次采样的班级内阳性数具有不独立性且相关性较强,本研究分别拟合3个多因素logistic回归分析模型(即模型1~3)。除“班级内阳性人数”变量外,3个模型在控制混杂因素及分析方法上保持一致。运用随机森林模型对肺炎链球菌持续携带相关的影响因素进行重要性排序。结果儿童肺炎链球菌持续携带率为6.6%。模型1的多因素logistic回归分析结果表明:班级内阳性人数越多,肺炎链球菌持续携带率越高且呈现单调递增趋势。以0~<4人阳性组为对照,其他组的OR分别为2.35(95%CI:1.12~4.90,P=0.023)、5.86(95%CI:2.75~12.49,P<0.001)、9.43(95%CI:4.68~19.02,P<0.001);随着儿童年龄的增长,肺炎链球菌持续携带率呈现递减趋势。以0~<3岁组为对照,其他组OR分别为0.38(95%CI:0.20~0.72,P=0.003)、0.29(95%CI:0.15~0.55,P<0.001)、0.29(95%CI:0.14~0.60,P=0.001);近1年内过敏性疾病史是肺炎链球菌持续携带的保护因素(OR=0.44,95%CI:0.20~0.98,P=0.045)。模型2和模型3的研究结果与模型1基本一致。结论班级内阳性人数增多是幼儿园儿童肺炎链球菌持续携带的重要危险因素;年龄的增长与近1年内过敏性疾病史是幼儿园儿童肺炎链球菌持续携带的保护因素。Objective To explore the prevalence and influencing factors of persistent carriage of Streptococcus pneumoniae(S.pneumoniae)in kindergarten children.Methods A multi-stage stratified cluster sampling method was used in this study.Healthy children were sampled from six kindergartens in Shunde District,Foshan City.All children underwent three nasal swab samplings,followed by isolation and identification of S.pneumoniae.Univariate chi-square tests and multivariate logistic regression analysis models were used to analyze the factors influencing persistent carriage of S.pneumoniae in children.Given the non-independence and strong correlation of the number of positive cases within classes across three samples,this study has developed three separate multivariable logistic regression analysis models(namely,models 1 to 3).Apart from the variable"number of positive cases within the class",all three models maintain consistency in controlling for confounding factors and in the analytical methods used.A random forest model was applied to rank the importance of factors associated with persistent carriage of S.pneumoniae.Results The persistence carriage rate of S.pneumoniae in children was 6.6%.The results of the multivariable logistic regression analysis in model 1 indicated that a higher number of positive cases within a class was associated with an increased rate of persistent carriage of S.pneumoniae,showing a monotonic increasing trend.Compared to the group with 0 to<4 positive cases,the odds ratios for other groups were 2.35(95%CI:1.12-4.90,P=0.023),5.86(95%CI:2.75-12.49,P<0.001),and 9.43(95%CI:4.68-19.02,P<0.001),respectively.The rate of persistent carriage of S.pneumoniae decreased with increasing age.Compared to the group aged 0 to<3 years,the odds ratios for other age groups were 0.38(95%CI:0.20-0.72,P=0.003),0.29(95%CI:0.15-0.55,P<0.001),and 0.29(95%CI:0.14-0.60,P=0.001),respectively.A history of allergic diseases within the past year was identified as a protective factor for the persistent carriage of S.pneumoniae,wi

关 键 词：肺炎链球菌 携带 影响因素 儿童 

分 类 号：R179[医药卫生—妇幼卫生保健] R378.12[医药卫生—公共卫生与预防医学]