儿童社区获得性肺炎病原体分析及对患儿T细胞水平的影响
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摘要
目的:探讨儿童社区获得性肺炎病原体分析及对患儿T细胞水平的影响。方法:选择2015年5月～2017年10月入院治疗的儿童社区获得性肺炎患者248例,采用间接免疫荧光法(IFA)、被动凝集法、酶联免疫吸附试验(ELISA)法、胶体金法、细菌培养法联合检测常见呼吸道病原体。根据不同病原菌将患者分为肺炎支(衣)原体肺炎、病毒性肺炎、细菌性肺炎、混合感染性肺炎及不明原因肺炎。所有社区获得性肺炎患者入院后次日早晨均空腹采集静脉血3 ml,完成血清分离后采用ELISA测定IL-17、IL-10及转化生长因子β1(TGF-β1)水平;采用流式细胞仪测定入组患者CD3+、CD4+、CD8+及CD19+水平,分析儿童社区获得性肺炎病原菌构成比及对患儿T细胞水平的影响。结果:病原学检测结果表明:248例患者病原学检测排在前三位的分别为:MP、细菌、RSV,分别占:43. 55%、13. 71%和10. 89%。肺炎支(衣)原体肺炎、混合感染性肺炎IL-17、TGF-β1,均高于病毒性肺炎、细菌性肺炎、不明原因肺炎(P<0. 05)。肺炎支(衣)原体肺炎、混合感染性肺炎CD8+,均高于病毒性肺炎、细菌性肺炎级不明原因肺炎(P<0. 05)。肺炎支(衣)原体肺炎、混合感染性肺炎CD4+/CD8+,均低于病毒性肺炎、细菌性肺炎级不明原因肺炎(P<0. 05)。结论:儿童社区获得性肺炎中肺炎支(衣)原体肺炎占据比重较大,能引起机体炎症水平联级反应,降低患儿T细胞水平,应及时采取有效措施进行干预,促进患者恢复。
Objective: To investigate the pathogen of community acquired pneumonia in children and its effect on T cell level. Methods: 248 children with community acquired pneumonia admitted to hospital from May 2015 to October 2017 were selected. Indirect immunofluorescence assay( IFA),passive agglutination assay,enzyme-linked immunosorbent assay( ELISA),colloidal gold assay and bacterial culture were used to detect common respiratory pathogens. According to different pathogenic bacteria,the patients were divided into three groups: mycoplasma pneumonia and chlamydia pneumonia,viral pneumonia,bacterial pneumonia,mixed infectious pneumonia and unexplained pneumonia. All patients with community acquired pneumonia were fasting to collect venous blood3 ml the next morning after admission. After serum separation,the levels of IL-17,IL-10 and transforming growth factor-beta 1( TGF-β1) were measured by ELISA. The levels of CD3+,CD4+,CD8+and CD19+were measured by flow cytometry,and the children's clubs were analyzed. Composition ratio of pathogenic bacteria of district acquired pneumonia and its effect on T cell level in children. Results:The results of etiological test showed that the top three pathogenic tests were MP,bacteria and RSV,accounting for 43. 55%,13. 71%and 10. 89% respectively. The levels of IL-17 and TGF-β1 in chlamydia pneumonia and mixed infectious pneumonia were higher than those in viral pneumonia,bacterial pneumonia and unexplained pneumonia( P<0. 05). The CD8+levels of mycoplasma pneumonia and chlamydia pneumonia and mixed infectious pneumonia were higher than those of viral pneumonia and bacterial pneumonia( P<0. 05).The ratio of CD4+/CD8+in mycoplasma pneumonia and chlamydia pneumonia and mixed infectious pneumonia was lower than that in viral pneumonia and bacterial pneumonia( P < 0. 05). Conclusion: Mycoplasma pneumonia and chlamydia pneumonia accounts for a large proportion in children with community acquired pneumonia. It can cause the level of inflammatory reaction and reduce the level of T cells in children. Effective measures should be taken to intervene in time to promote the recovery of patients.
Objective: To investigate the pathogen of community acquired pneumonia in children and its effect on T cell level. Methods: 248 children with community acquired pneumonia admitted to hospital from May 2015 to October 2017 were selected. Indirect immunofluorescence assay( IFA),passive agglutination assay,enzyme-linked immunosorbent assay( ELISA),colloidal gold assay and bacterial culture were used to detect common respiratory pathogens. According to different pathogenic bacteria,the patients were divided into three groups: mycoplasma pneumonia and chlamydia pneumonia,viral pneumonia,bacterial pneumonia,mixed infectious pneumonia and unexplained pneumonia. All patients with community acquired pneumonia were fasting to collect venous blood3 ml the next morning after admission. After serum separation,the levels of IL-17,IL-10 and transforming growth factor-beta 1( TGF-β1) were measured by ELISA. The levels of CD3+,CD4+,CD8+and CD19+were measured by flow cytometry,and the children's clubs were analyzed. Composition ratio of pathogenic bacteria of district acquired pneumonia and its effect on T cell level in children. Results:The results of etiological test showed that the top three pathogenic tests were MP,bacteria and RSV,accounting for 43. 55%,13. 71%and 10. 89% respectively. The levels of IL-17 and TGF-β1 in chlamydia pneumonia and mixed infectious pneumonia were higher than those in viral pneumonia,bacterial pneumonia and unexplained pneumonia( P<0. 05). The CD8+levels of mycoplasma pneumonia and chlamydia pneumonia and mixed infectious pneumonia were higher than those of viral pneumonia and bacterial pneumonia( P<0. 05).The ratio of CD4+/CD8+in mycoplasma pneumonia and chlamydia pneumonia and mixed infectious pneumonia was lower than that in viral pneumonia and bacterial pneumonia( P < 0. 05). Conclusion: Mycoplasma pneumonia and chlamydia pneumonia accounts for a large proportion in children with community acquired pneumonia. It can cause the level of inflammatory reaction and reduce the level of T cells in children. Effective measures should be taken to intervene in time to promote the recovery of patients.
引文
[1]王盈红,曹小彩,宋文涛,等.细菌和病毒混合感染对儿童社区获得性肺炎的影响[J].临床儿科杂志,2016,34(5):342-347.Wang YH,Cao XC,Song WT,et al. Effects of mixed infection of bacteria and viruses on community acquired pneumonia in children[J]. Clin J Pediat,2016,34(5):342-347.
[2] Hsieh YC,Chi H,Chang KY,et al. Increase in fitness of Streptococcus pneumoniae is associated with the severity of necrotizing pneumonia[J]. Pediat Infect Dis J, 2015, 34(5):499.
[3]许姜姜,舒林华,钟海琴,等.不同感染类型的儿童社区获得性肺炎流行病学特征研究[J].现代预防医学,2016,43(16):2909-2912.Xu JJ,Shu LH,Zhong HQ,et al. Epidemiological characteristics of different types of infection in children with community-acquired pneumonia[J]. Modern Prevent Med,2016,43(16):2909-2912.
[4] Wei L,Liu W,Zhang XA,et al. Detection of viral and bacterial pathogens in hospitalized children with acute respiratory illnesses,Chongqing,2009-2013[J]. Medicine,2015,94(16):e742.
[5]彭懿,舒畅,符州,等.儿童社区获得性肺炎1613例病原学特点分析[J].中国当代儿科杂志,2015,17(11):1193-1199.Peng Y,Shu C,Fu Z,et al. Analysis of the etiological characteristics of 1613 cases of children's community-acquired pneumonia[J]. Chin J Contemporary Pediat,2015,17(11):1193-1199.
[6] Voiriot G,Visseaux B,Cohen J,et al. Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia[J]. Crit Care, 2016, 20(1):375.
[7]舒林华,许姜姜,王淑,等.儿童社区获得性肺炎致病微生物分布及与临床特征的相关性[J].中国当代儿科杂志,2015,17(10):1056-1061.Shu LH,Xu JJ,Wang S,et al. The distribution of pathogenic microorganism in children's community acquired pneumonia and its correlation with clinical characteristics[J]. Chin J Contemporary Pediat,2015,17(10):1056-1061.
[8] Zhanel GG,Hartel E,Adam H,et al. Solithromycin:A novel fluoroketolide for the treatment of community-acquired bacterial pneumonia[J]. Drugs,2016,76(18):1-21.
[9]刘珺,王荃,钱素云,等.经鼻持续气道正压通气治疗5岁以下儿童社区获得性肺炎:多中心临床研究[J].中华儿科杂志,2017,55(5):329-333.Liu J,Wang Q,Qian SY,et al. Nasal continuous positive airway pressure treatment for children under 5 years old with community acquired pneumonia:multicenter clinical research[J]. Chin J Pediat,2017,55(5):329-333.
[10] Wen TS,Koay SC,Lee CK,et al. The use of polymerase chain reaction amplification for the detection of viruses and bacteria in severe community-acquired pneumonia[J]. Respiration,2016,92(5):286.
[11]张翊玲,张正玲,张湘燕,等.不同病原体感染所致的社区获得性肺炎患者血清中TGF-β1、IL-17及IL-10的水平变化分析检测[J].细胞与分子免疫学,2015,31(11):1541-1543.Zhang YL,Zhang ZL,Zhang XY,et al. Serum levels of TGF-,1,IL-17 and IL-10 in patients with community-acquired pneumonia caused by different pathogen infection were analyzed[J]. Cell Mol Immunol,2015,31(11):1541-1543.
[12] Wort AS,Gale M,Devine K,et al. S73 Viruses associated with community-acquired pneumonia in children-a large prospective study in the post-prevenar 13 era[J]. Thorax,2016,Suppl 3(A43):A43-A43.
[13]陆芸芸,罗蓉,符州.儿童重症社区获得性肺炎病原体分布及细菌耐药情况分析[J].中国当代儿科杂志,2017,19(9):983-988.Lu YY,Luo R,Fu Z. Distribution and drug resistance of pathogens in children with severe community acquired pneumonia[J]. Chin J Contemporary Pediat,2017,19(9):983-988.
[14] Andrews AL,Simpson AN,Heine D,et al. A cost-effectiveness analysis of obtaining blood cultures in children hospitalized for community-acquired pneumonia[J]. J Pediat,2015,167(6):1280-1286.
[15]田玉恒,郑有光,王彤兵,等.莫西沙星联合喜炎平对社区获得性肺炎老年患者血清炎症因子水平及T淋巴细胞亚群的影响[J].中华医院感染学杂志,2016,26(15):3389-3391.Tian YH,Zheng YG,Wang TB,et al. Effect of moxifloxacin combined with Xiyanping obtained Journal of infectious pneumonia in elderly patients,the serum levels of inflammatory factors and T lymphocyte subpopulations of[J]. Chin J Nosocomiol,2016,26(15):3389-3391.
[16] Cannavino CR,Nemeth A,Korczowski B,et al. A randomized,prospective study of pediatric patients with community-acquired pneumonia treated with ceftaroline vs. ceftriaxone[J]. Pediat Infect Dis J,2016,35(7):752.
[17]武敏,王宇清,郝创利,等.社区获得性肺炎住院患儿混合感染研究[J].中国实用儿科杂志,2017,32(9):698-703.Wu M,Wang YQ,Hao CL,et al. Study on mixed infection in hospitalized children with community-acquired pneumonia[J]. Chin Pediat,2017,32(9):698-703.
[18] Oldach D,Barrera C,Rowe B,et al. Results from a phase 3 trial in moderate to moderately severe community acquired bacterial pneumonia(CABP)treated as outpatients with a new oral macrolide,solithromycin[J]. Chest,2015,148(4):78A dal.
[19]贵琳,吴晓林,朱松柏,等.靶序列富集多重聚合酶链式反应在儿童细菌性肺炎病原体检测中的应用[J].中华医院感染学杂志,2017,27(17):4004-4007.Gui L,Wu XL,Zhu SB,et al. Application of target sequence enrichment multiplex polymerase chain reaction in pathogen detection of bacterial pneumonia in children[J]. Chin J Nosocomiol,2017,27(17):4004-4007.
[20]马慧轩,孙琳,吴喜蓉,等.北京单中心社区获得性肺炎住院患儿病原学分析[J].中国循证儿科杂志,2015,10(5):361-365.Ma HX,Sun L,Wu XR,et al. Etiology analysis of hospitalized children with single center community-acquired pneumonia in Beijing[J]. Chin J Evidence-based Pediat,2015,10(5):361-365.
[21] Park S,Oh K C,Kim KS,et al. Role of atypical pathogens and the antibiotic prescription pattern in acute bronchitis:a multicenter study in Korea[J]. J Korean Med Sci,2015,30(10):1446-1452.
[22]张莉,宁璞,荣芳,等.不同时期成人重症社区获得性肺炎预后及病原体的变迁[J].中华医学杂志,2017,97(5):332-337.Zhang L,Ning P,Rong F,et al. Different period of adult patients with community acquired pneumonia pathogens change prognosis and[J]. Chin Med J,2017,97(5):332-337.
[23] Ito R,Shindo Y,Kobayashi D,et al. Molecular epidemiological characteristics of Klebsiella pneumoniae associated with bacteremia among patients with pneumonia[J]. J Clin Microbiol,2015,53(3):879-886.
[24]苑鑫,金欣,牛文凯,等.肺炎支原体肺炎快速评分法对社区获得性肺炎病原学的辅助诊断价值[J].中华结核和呼吸杂志,2015,38(7):497-500.Yuan X,Jin X,Niu WK,et al. Mycoplasma pneumoniae rapid evaluation method of community acquired pneumonia diagnosis[J]. Chin J Tuberculosis Resp Dis,2015,38(7):497-500.
[25] Collins AM,Johnstone CMK,Gritzfeld JF,et al. Pneumococcal colonization rates in patients admitted to a united kingdom hospital with lower respiratory tract infection:a prospective casecontrol Study[J]. J Clin Microbiol,2016,54(4):944-949.
[26]刘艳,刘丹,黄泽智,等.湖南地区4276例急性呼吸道感染患儿肺炎支原体感染状况及药敏分析[J].临床儿科杂志,2015,33(2):195-196.Liu Y,Liu D,Huang ZZ,et al. Mycoplasma pneumoniae infection and drug sensitivity in 4276 children with acute respiratory tract infection in Hunan area[J]. Clin Pediat,2015,33(2):195-196.
[27]刘琳,张湘燕,高占成.气道分泌物病原菌培养在呼吸系统感染诊断中的应用价值[J].山东医药,2016,56(31):103-105.Liu L,Zhang XY,Gao ZC. High pathogenic fungi secretion of airway culture in the diagnosis of the application value of respiratory infection in[J]. Shandong Med J,2016,56(31):103-105.
[28] Viitanen SJ,Lappalainen AK,Christensen MB,et al. The utility of acute-phase proteins in the assessment of treatment response in dogs with bacterial pneumonia[J]. J Vet Intern Med,2017,31(1):124.
[29]彭春红,叶贤伟,张湘燕.社区获得性肺炎病原谱的构成及病原菌快速检测方法的进展[J].中华结核和呼吸杂志,2016,39(4):311-312.Peng CH,Ye XW,Zhang XY. The composition and method for detecting the pathogenic bacteria of pneumonia pathogens in community[J]. Chin J Tuberculosis Resp Dis,2016,39(4):311-312.
[30] Barrera CM,Mykietiuk A,Metev H,et al. Efficacy and safety of oral solithromycin versus oral moxifloxacin for treatment of community-acquired bacterial pneumonia:a global,double-blind,multicentre,randomised,active-controlled,non-inferiority trial(SOLITAIRE-ORAL)[J]. Lancet Infect Dis, 2016, 16(4):421.
[2] Hsieh YC,Chi H,Chang KY,et al. Increase in fitness of Streptococcus pneumoniae is associated with the severity of necrotizing pneumonia[J]. Pediat Infect Dis J, 2015, 34(5):499.
[3]许姜姜,舒林华,钟海琴,等.不同感染类型的儿童社区获得性肺炎流行病学特征研究[J].现代预防医学,2016,43(16):2909-2912.Xu JJ,Shu LH,Zhong HQ,et al. Epidemiological characteristics of different types of infection in children with community-acquired pneumonia[J]. Modern Prevent Med,2016,43(16):2909-2912.
[4] Wei L,Liu W,Zhang XA,et al. Detection of viral and bacterial pathogens in hospitalized children with acute respiratory illnesses,Chongqing,2009-2013[J]. Medicine,2015,94(16):e742.
[5]彭懿,舒畅,符州,等.儿童社区获得性肺炎1613例病原学特点分析[J].中国当代儿科杂志,2015,17(11):1193-1199.Peng Y,Shu C,Fu Z,et al. Analysis of the etiological characteristics of 1613 cases of children's community-acquired pneumonia[J]. Chin J Contemporary Pediat,2015,17(11):1193-1199.
[6] Voiriot G,Visseaux B,Cohen J,et al. Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia[J]. Crit Care, 2016, 20(1):375.
[7]舒林华,许姜姜,王淑,等.儿童社区获得性肺炎致病微生物分布及与临床特征的相关性[J].中国当代儿科杂志,2015,17(10):1056-1061.Shu LH,Xu JJ,Wang S,et al. The distribution of pathogenic microorganism in children's community acquired pneumonia and its correlation with clinical characteristics[J]. Chin J Contemporary Pediat,2015,17(10):1056-1061.
[8] Zhanel GG,Hartel E,Adam H,et al. Solithromycin:A novel fluoroketolide for the treatment of community-acquired bacterial pneumonia[J]. Drugs,2016,76(18):1-21.
[9]刘珺,王荃,钱素云,等.经鼻持续气道正压通气治疗5岁以下儿童社区获得性肺炎:多中心临床研究[J].中华儿科杂志,2017,55(5):329-333.Liu J,Wang Q,Qian SY,et al. Nasal continuous positive airway pressure treatment for children under 5 years old with community acquired pneumonia:multicenter clinical research[J]. Chin J Pediat,2017,55(5):329-333.
[10] Wen TS,Koay SC,Lee CK,et al. The use of polymerase chain reaction amplification for the detection of viruses and bacteria in severe community-acquired pneumonia[J]. Respiration,2016,92(5):286.
[11]张翊玲,张正玲,张湘燕,等.不同病原体感染所致的社区获得性肺炎患者血清中TGF-β1、IL-17及IL-10的水平变化分析检测[J].细胞与分子免疫学,2015,31(11):1541-1543.Zhang YL,Zhang ZL,Zhang XY,et al. Serum levels of TGF-,1,IL-17 and IL-10 in patients with community-acquired pneumonia caused by different pathogen infection were analyzed[J]. Cell Mol Immunol,2015,31(11):1541-1543.
[12] Wort AS,Gale M,Devine K,et al. S73 Viruses associated with community-acquired pneumonia in children-a large prospective study in the post-prevenar 13 era[J]. Thorax,2016,Suppl 3(A43):A43-A43.
[13]陆芸芸,罗蓉,符州.儿童重症社区获得性肺炎病原体分布及细菌耐药情况分析[J].中国当代儿科杂志,2017,19(9):983-988.Lu YY,Luo R,Fu Z. Distribution and drug resistance of pathogens in children with severe community acquired pneumonia[J]. Chin J Contemporary Pediat,2017,19(9):983-988.
[14] Andrews AL,Simpson AN,Heine D,et al. A cost-effectiveness analysis of obtaining blood cultures in children hospitalized for community-acquired pneumonia[J]. J Pediat,2015,167(6):1280-1286.
[15]田玉恒,郑有光,王彤兵,等.莫西沙星联合喜炎平对社区获得性肺炎老年患者血清炎症因子水平及T淋巴细胞亚群的影响[J].中华医院感染学杂志,2016,26(15):3389-3391.Tian YH,Zheng YG,Wang TB,et al. Effect of moxifloxacin combined with Xiyanping obtained Journal of infectious pneumonia in elderly patients,the serum levels of inflammatory factors and T lymphocyte subpopulations of[J]. Chin J Nosocomiol,2016,26(15):3389-3391.
[16] Cannavino CR,Nemeth A,Korczowski B,et al. A randomized,prospective study of pediatric patients with community-acquired pneumonia treated with ceftaroline vs. ceftriaxone[J]. Pediat Infect Dis J,2016,35(7):752.
[17]武敏,王宇清,郝创利,等.社区获得性肺炎住院患儿混合感染研究[J].中国实用儿科杂志,2017,32(9):698-703.Wu M,Wang YQ,Hao CL,et al. Study on mixed infection in hospitalized children with community-acquired pneumonia[J]. Chin Pediat,2017,32(9):698-703.
[18] Oldach D,Barrera C,Rowe B,et al. Results from a phase 3 trial in moderate to moderately severe community acquired bacterial pneumonia(CABP)treated as outpatients with a new oral macrolide,solithromycin[J]. Chest,2015,148(4):78A dal.
[19]贵琳,吴晓林,朱松柏,等.靶序列富集多重聚合酶链式反应在儿童细菌性肺炎病原体检测中的应用[J].中华医院感染学杂志,2017,27(17):4004-4007.Gui L,Wu XL,Zhu SB,et al. Application of target sequence enrichment multiplex polymerase chain reaction in pathogen detection of bacterial pneumonia in children[J]. Chin J Nosocomiol,2017,27(17):4004-4007.
[20]马慧轩,孙琳,吴喜蓉,等.北京单中心社区获得性肺炎住院患儿病原学分析[J].中国循证儿科杂志,2015,10(5):361-365.Ma HX,Sun L,Wu XR,et al. Etiology analysis of hospitalized children with single center community-acquired pneumonia in Beijing[J]. Chin J Evidence-based Pediat,2015,10(5):361-365.
[21] Park S,Oh K C,Kim KS,et al. Role of atypical pathogens and the antibiotic prescription pattern in acute bronchitis:a multicenter study in Korea[J]. J Korean Med Sci,2015,30(10):1446-1452.
[22]张莉,宁璞,荣芳,等.不同时期成人重症社区获得性肺炎预后及病原体的变迁[J].中华医学杂志,2017,97(5):332-337.Zhang L,Ning P,Rong F,et al. Different period of adult patients with community acquired pneumonia pathogens change prognosis and[J]. Chin Med J,2017,97(5):332-337.
[23] Ito R,Shindo Y,Kobayashi D,et al. Molecular epidemiological characteristics of Klebsiella pneumoniae associated with bacteremia among patients with pneumonia[J]. J Clin Microbiol,2015,53(3):879-886.
[24]苑鑫,金欣,牛文凯,等.肺炎支原体肺炎快速评分法对社区获得性肺炎病原学的辅助诊断价值[J].中华结核和呼吸杂志,2015,38(7):497-500.Yuan X,Jin X,Niu WK,et al. Mycoplasma pneumoniae rapid evaluation method of community acquired pneumonia diagnosis[J]. Chin J Tuberculosis Resp Dis,2015,38(7):497-500.
[25] Collins AM,Johnstone CMK,Gritzfeld JF,et al. Pneumococcal colonization rates in patients admitted to a united kingdom hospital with lower respiratory tract infection:a prospective casecontrol Study[J]. J Clin Microbiol,2016,54(4):944-949.
[26]刘艳,刘丹,黄泽智,等.湖南地区4276例急性呼吸道感染患儿肺炎支原体感染状况及药敏分析[J].临床儿科杂志,2015,33(2):195-196.Liu Y,Liu D,Huang ZZ,et al. Mycoplasma pneumoniae infection and drug sensitivity in 4276 children with acute respiratory tract infection in Hunan area[J]. Clin Pediat,2015,33(2):195-196.
[27]刘琳,张湘燕,高占成.气道分泌物病原菌培养在呼吸系统感染诊断中的应用价值[J].山东医药,2016,56(31):103-105.Liu L,Zhang XY,Gao ZC. High pathogenic fungi secretion of airway culture in the diagnosis of the application value of respiratory infection in[J]. Shandong Med J,2016,56(31):103-105.
[28] Viitanen SJ,Lappalainen AK,Christensen MB,et al. The utility of acute-phase proteins in the assessment of treatment response in dogs with bacterial pneumonia[J]. J Vet Intern Med,2017,31(1):124.
[29]彭春红,叶贤伟,张湘燕.社区获得性肺炎病原谱的构成及病原菌快速检测方法的进展[J].中华结核和呼吸杂志,2016,39(4):311-312.Peng CH,Ye XW,Zhang XY. The composition and method for detecting the pathogenic bacteria of pneumonia pathogens in community[J]. Chin J Tuberculosis Resp Dis,2016,39(4):311-312.
[30] Barrera CM,Mykietiuk A,Metev H,et al. Efficacy and safety of oral solithromycin versus oral moxifloxacin for treatment of community-acquired bacterial pneumonia:a global,double-blind,multicentre,randomised,active-controlled,non-inferiority trial(SOLITAIRE-ORAL)[J]. Lancet Infect Dis, 2016, 16(4):421.