小儿气管支气管软化症合并肺炎与单纯肺炎呼吸道病原分布特点对比分析
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摘要
目的:研究气管支气管软化症(tracheobronchomalacia,TBM)合并肺炎与单纯肺炎患儿呼吸道病原分布特点的差异性。方法:回顾性分析2012年1月至2016年12月我院收治的TBM合并肺炎患儿(TBM组)及单纯肺炎患儿(NTBM组)各337例的病史及支气管肺泡灌洗液标本病原资料,再进一步以年龄(<1岁、≥1岁)、肺炎严重程度(重症、非重症)分组进行组间比较。结果:(1)整体上,TBM组、NTBM组总细菌检出率分别为54.90%、45.99%,差异有统计学意义(P=0.021),前4位细菌均为肺炎链球菌、大肠埃希菌、肺炎克雷伯菌、副流感嗜血杆菌,大肠埃希菌检出率分别为12.17%、4.75%,差异有统计学意义(P=0.001)。(2)非重症组中,TBM组、NTBM组细菌检出率分别为57.75%、47.62%,大肠埃希菌检出率分别为11.24%、4.40%,肺炎克雷伯菌检出率分别为10.46%、4.40%,差异均有统计学意义(P=0.019,P=0.003,P=0.007);<1岁组中,2组大肠埃希菌检出率分别为13.89%、5.31%,差异有统计学意义(P=0.001)。(3)2组首位病毒为呼吸道合胞病毒,总病毒、呼吸道合胞病毒、肺炎支原体检出率均无统计学意义(P=0.361,P=0.502,P=0.055);肺炎衣原体未检出。结论:(1)TBM合并肺炎患儿细菌分布特点较单纯肺炎患儿有差异,大肠埃希菌感染多见,尤其在<1岁患儿中占首位。(2)非重症组中,TBM合并肺炎患儿细菌感染较单纯肺炎患儿多见,其中大肠埃希菌检出率明显增加。(3)两者病毒、肺炎支原体分布特点无差异,肺炎衣原体在本研究中未见。
Objective:To study the difference of respiratory pathogen distribution in children with Tracheobronchomalacia(TBM)complicated pneumonia and children with simple pneumonia. Methods:Retrospectively analyze medical records and bronchoalveolar lavage fluid(BALF)specimen data of two groups,children with tracheobronchomalacia complicated pneumonia which named TBM group and children with simple pneumonia which named NTBM group,from January 2012 to December 2016 in Children's Hospital of Chongqing Medical University,with 337 cases in each group. According to their age,they were divided into infant group(aged 0 days to 1 year)and young children group(aged 1 to 3 years). According to the severity of pneumonia,they were divided into severe pneumonia group and non-severe pneumonia group. Then data was compared in groups. Results:(1)As a whole,in TBM group and NTBM group,the total bacteria positive rate were 54.90% and45.99%,and with significant difference(P=0.021). The tops four bacteria were Streptococcus pneumoniae,Escherichia coli,Klebsiella pneumoniae and Hemophilus parainfluenzae. The positive rate of Escherichia coli were 12.17% and 4.75%,and respectively with significant difference(P=0.001)among two groups.(2)Considering the non-severe pneumonia group,in TBM group and NTBM group,the positive rate of bacteria were 57.75% and 47.62%,the positive rate of Escherichia coli were 11.24% and 4.40%,and the positive rate of Klebsiella pneumoniae were 10.46% and 4.40%,respectively with significant difference(P=0.019,P=0.003,P=0.007)among two groups. As to bacterial type in infant group,the Escherichia coli ranked first in TBM group and the Streptococcus pneumonia ranked first in NTBM group. The Escherichia coli postive rate of two groups were 13.89% and 5.31% respectively,with significant difference(P=0.001).(3)Respiratory syncytial virus(RVS)ranked first in TBM group and NTBM group,with no significant difference(P=0.502). There was no significant difference in total virus positive rate and Mycoplasma pneumonia positive rate between the two groups(P =0.361,P =0.055). Chlamydia pneumonia positive rate was 0. Conclusion:(1) Difference in bacterial distribution existed between TBM complicated pneumonia and simple pneumonia. The distribution was the most in Escherichia coli,which ranked first in infant particularly.(2) In the non-severe pneumonia group,bacterial infection rate of children with TBM complicated pneumonia was higher than that of children with simple pneumonia,among which the Escherichia coli infection rate was significantly higher.(3)In term of the distribution of virus and Mycoplasma pneumonia,there was no significant difference between children with TBM complicated pneumonia and children with simple pneumonia. Chlamydia pneumonia infection was not found in the study.
Objective:To study the difference of respiratory pathogen distribution in children with Tracheobronchomalacia(TBM)complicated pneumonia and children with simple pneumonia. Methods:Retrospectively analyze medical records and bronchoalveolar lavage fluid(BALF)specimen data of two groups,children with tracheobronchomalacia complicated pneumonia which named TBM group and children with simple pneumonia which named NTBM group,from January 2012 to December 2016 in Children's Hospital of Chongqing Medical University,with 337 cases in each group. According to their age,they were divided into infant group(aged 0 days to 1 year)and young children group(aged 1 to 3 years). According to the severity of pneumonia,they were divided into severe pneumonia group and non-severe pneumonia group. Then data was compared in groups. Results:(1)As a whole,in TBM group and NTBM group,the total bacteria positive rate were 54.90% and45.99%,and with significant difference(P=0.021). The tops four bacteria were Streptococcus pneumoniae,Escherichia coli,Klebsiella pneumoniae and Hemophilus parainfluenzae. The positive rate of Escherichia coli were 12.17% and 4.75%,and respectively with significant difference(P=0.001)among two groups.(2)Considering the non-severe pneumonia group,in TBM group and NTBM group,the positive rate of bacteria were 57.75% and 47.62%,the positive rate of Escherichia coli were 11.24% and 4.40%,and the positive rate of Klebsiella pneumoniae were 10.46% and 4.40%,respectively with significant difference(P=0.019,P=0.003,P=0.007)among two groups. As to bacterial type in infant group,the Escherichia coli ranked first in TBM group and the Streptococcus pneumonia ranked first in NTBM group. The Escherichia coli postive rate of two groups were 13.89% and 5.31% respectively,with significant difference(P=0.001).(3)Respiratory syncytial virus(RVS)ranked first in TBM group and NTBM group,with no significant difference(P=0.502). There was no significant difference in total virus positive rate and Mycoplasma pneumonia positive rate between the two groups(P =0.361,P =0.055). Chlamydia pneumonia positive rate was 0. Conclusion:(1) Difference in bacterial distribution existed between TBM complicated pneumonia and simple pneumonia. The distribution was the most in Escherichia coli,which ranked first in infant particularly.(2) In the non-severe pneumonia group,bacterial infection rate of children with TBM complicated pneumonia was higher than that of children with simple pneumonia,among which the Escherichia coli infection rate was significantly higher.(3)In term of the distribution of virus and Mycoplasma pneumonia,there was no significant difference between children with TBM complicated pneumonia and children with simple pneumonia. Chlamydia pneumonia infection was not found in the study.
引文
[1]潘炜,彭东红.儿童气管支气管软化症研究现状[J].中国现代医生,2014,52(9):154-156.
[2]Snijders D,Barbato A.An update on diagnosis of tracheomalacia in children[J].Eur J Pediatr Surg,2015,25(4):333-335.
[3]罗征秀,刘恩梅,李渠北,等.婴幼儿反复、持续吼喘58例病因分析[J].临床儿科杂志,2006,24(6):478-479.
[4]Kantar A,Bernardini R,Paravati F,et al.Chronic cough in preschool children[J].Early Hum Dev,2013,89(S3):19-24.
[5]Biswas A,Jantz MA,Sriram PS,et al.Tracheobronchomalacia[J].Dis Mon,2017,63(10):287-302.
[6]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[7]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(下)[J].中华儿科杂志,2013,51(11):756-762.
[8]李惠民,江载芳,江沁波,等.小儿反复肺炎的基础疾病和诊断分析[J].中国实用儿科杂志,2004,19(3):153-155.
[9]Masters IB,Zimmerman PV,Pandeya N,et a1.Quantifed tracheobronchomalacia disorders and their clinical profiles in children[J].Chest Journal,2008,133(2):461-467.
[10]Torres A,Ewing S,Insausti J,et al.Etiology and microbial patterns of pulmonary infiltrates in patients with orthotopic liver transplantation[J].Chest,2000,117(2):494-502.
[11]Rudan I,O'Brien KL,Nair H,et al.Epidemiology and etiology of childhood pneumonia in 2010:estimates of incidence,severe morbidity,mortality,underlying risk factors and causative pathogens for 192 countries[J].J Glob Health,2013,3(1):010401.
[12]Padilla Ygreda J,Lindo pérez F,Rojas Galarza R,et al.Etiology of community acquired pneumonia in children 2-59 months old in two ecologically different communities from Peru[J].Arch Argents Pediatr,2010,108(6):516-523.
[13]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):1193-1198.
[14]孙秋凤,严永东,陈正荣,等.下呼吸道感染性疾病7794例病原分布研究[J].中国实用儿科杂志,2014,29(3):214-217.
[15]中华医学会呼吸病学分会.肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版)[J].中华结核和呼吸杂志,2017,40(8):578-583.
[16]Pan W,Peng DH,Luo J,et al.Clinical features of airway malacia in children:a retrospective analysis of 459 patients[J].Int J Clin Exp Med,2014,7(9):3005-3012.
[17]刘晟,张亚丽,蔡海芳.婴儿大肠埃希菌肺炎临床特点及耐药性分析[J].临床儿科杂志,2014,32(3):228-231.
[18]谢庆玲,唐晓燕,甄宏,等.婴幼儿大肠埃希菌性肺炎117例临床分析[J].中国临床新医学,2014,7(2):108-111.
[19]冯杰,周燕明,王予川,等.先天性心脏病并下呼吸道感染患儿病原学及细菌耐药性分析[J].实用儿科临床杂志,2012,27(13):1003-1004,1015.
[20]冯录召,赖圣杰,李夫,等.2009-2012年我国6省(市)5岁以下儿童住院肺炎病例的病毒病原学分析[J].中华流行病学杂志,2014,35(6):646-649.
[21]Jain S,Williams DJ,Arnold SR,et al.Community-acquired pneumonia requiring hospitalization among U.S.children[J].N Engl J Med,2015,372(9):835-845.
[2]Snijders D,Barbato A.An update on diagnosis of tracheomalacia in children[J].Eur J Pediatr Surg,2015,25(4):333-335.
[3]罗征秀,刘恩梅,李渠北,等.婴幼儿反复、持续吼喘58例病因分析[J].临床儿科杂志,2006,24(6):478-479.
[4]Kantar A,Bernardini R,Paravati F,et al.Chronic cough in preschool children[J].Early Hum Dev,2013,89(S3):19-24.
[5]Biswas A,Jantz MA,Sriram PS,et al.Tracheobronchomalacia[J].Dis Mon,2017,63(10):287-302.
[6]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志,2013,51(10):745-752.
[7]中华医学会儿科学分会呼吸学组,《中华儿科杂志》编辑委员会.儿童社区获得性肺炎管理指南(2013修订)(下)[J].中华儿科杂志,2013,51(11):756-762.
[8]李惠民,江载芳,江沁波,等.小儿反复肺炎的基础疾病和诊断分析[J].中国实用儿科杂志,2004,19(3):153-155.
[9]Masters IB,Zimmerman PV,Pandeya N,et a1.Quantifed tracheobronchomalacia disorders and their clinical profiles in children[J].Chest Journal,2008,133(2):461-467.
[10]Torres A,Ewing S,Insausti J,et al.Etiology and microbial patterns of pulmonary infiltrates in patients with orthotopic liver transplantation[J].Chest,2000,117(2):494-502.
[11]Rudan I,O'Brien KL,Nair H,et al.Epidemiology and etiology of childhood pneumonia in 2010:estimates of incidence,severe morbidity,mortality,underlying risk factors and causative pathogens for 192 countries[J].J Glob Health,2013,3(1):010401.
[12]Padilla Ygreda J,Lindo pérez F,Rojas Galarza R,et al.Etiology of community acquired pneumonia in children 2-59 months old in two ecologically different communities from Peru[J].Arch Argents Pediatr,2010,108(6):516-523.
[13]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):1193-1198.
[14]孙秋凤,严永东,陈正荣,等.下呼吸道感染性疾病7794例病原分布研究[J].中国实用儿科杂志,2014,29(3):214-217.
[15]中华医学会呼吸病学分会.肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版)[J].中华结核和呼吸杂志,2017,40(8):578-583.
[16]Pan W,Peng DH,Luo J,et al.Clinical features of airway malacia in children:a retrospective analysis of 459 patients[J].Int J Clin Exp Med,2014,7(9):3005-3012.
[17]刘晟,张亚丽,蔡海芳.婴儿大肠埃希菌肺炎临床特点及耐药性分析[J].临床儿科杂志,2014,32(3):228-231.
[18]谢庆玲,唐晓燕,甄宏,等.婴幼儿大肠埃希菌性肺炎117例临床分析[J].中国临床新医学,2014,7(2):108-111.
[19]冯杰,周燕明,王予川,等.先天性心脏病并下呼吸道感染患儿病原学及细菌耐药性分析[J].实用儿科临床杂志,2012,27(13):1003-1004,1015.
[20]冯录召,赖圣杰,李夫,等.2009-2012年我国6省(市)5岁以下儿童住院肺炎病例的病毒病原学分析[J].中华流行病学杂志,2014,35(6):646-649.
[21]Jain S,Williams DJ,Arnold SR,et al.Community-acquired pneumonia requiring hospitalization among U.S.children[J].N Engl J Med,2015,372(9):835-845.