中山市社区儿童获得性肺炎病原学分布特点及与气象因素相关性研究
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摘要
目的了解中山市儿童社区获得性肺炎(community-acquired pneumonia,CAP)病原学分布特点及与气象因素的关系,为儿童CAP的预防、诊断及合理用药提供指导和依据。方法选取2014年9月至2016年8月在中山市博爱医院住院的13 705例CAP患儿病例,采用间接免疫荧光法(IFA)、酶联免疫吸附试验(ELISA)法、胶体金法和细菌培养法联合检测患儿痰、咽拭子、血样本、肺泡灌洗液中的呼吸道病原微生物,对各种病原微生物在不同性别、年龄、季节、气象的分布及特点进行分析。结果 13 705例患儿中,病原学检测阳性数为8 412例,阳性率为61.38%,检出率排在前3位的是呼吸道合胞病毒2 660例(19.41%)、肺炎支原体2 195例(16.02%)和流感嗜血杆菌1 798例(13.12%);混合感染率为34.27%。男女患儿的肺炎支原体感染率不同(χ~2=103.900,P<0.01);肺炎支原体检出率夏秋季高于春冬季(χ~2=101.188,P<0.01),流感病毒检出率春季最高(χ~2=123.415,P<0.01),呼吸道合胞病毒检出率则是冬春季高于夏秋季(χ~2=317.574,P<0.01);肺炎支原体和副流感病毒检出率与月平均日照、月平均温度呈正相关;流感病毒检出率与月平均湿度呈正相关。结论 CAP患儿病原微生物检出率在不同年龄段及季节有不同,呼吸道合胞病毒在儿童CAP病原微生物中占据着重要的地位,好发于冬春季;流感嗜血杆菌占儿童CAP细菌感染病原的首位;警惕夏秋季节儿童肺炎支原体感染率升高,尤其是月平均日照和温度增加时的流行。
Objective To understand the etiology of community-acquired pneumonia(CAP) among hospitalized children in Zhongshan and to analyze its relation with climate parameters. Methods Total 13 705 children with CAP hospitalized in Zhongshan Boai Hospital from September 2014 to August 2016 were included in the study.Respiratory pathogenic microorganism in sputum, swabs, blood, and lveolar lavage were detected by indirect immunofluorescence(IFA), enzyme-linked immunosorbent assay(ELISA),the colloidal gold and bacterial culture. Results Out of 13 705 cases, 8 412 were positive for etiological testing with the positive rate of 61.38%.The top three were respiratory syncytial virus 2 660(19.41%), mycoplasma pneumoniae 2 195(16.02%) and hemophilies influenzae 1 798(13.12%).The coinfection rate was 34.27%.The infection rate of mycoplasma pneumoniae was different between male and female cases(χ~2=103.900, P<0.01).The positive rate of MP was significantly higher in summer and autumn than in spring and winter(χ~2=101.188,P<0.01);while,the positive rate of Flu virus was higher in spring(χ~2=123.415,P<0.01),RSV detection rate was significantly higher in the spring and winter(χ~2=317.574,P<0.01).The detection of mycoplasma pneumoniae and parainfluenza were positively correlated with the monthly average time of sunshine and the average temperature,while,the detection of Influenza virus was positively correlated with the monthly average humidity. Conclusions The detection rate of pathogenic microorganism varies among children with CAP in different age group and in different season as well.Respiratory syncytial virus plays the most important role in the pathogenic microorganisms of children with CAP,especially in spring and winter,Hemophilus influenzae is the leading infectious agent of CAP.in children.The infection rate of Mycoplasma pneumoniae in children increases in summer and autumn,especially during the elevation of monthly average sunshine time and temperature.
Objective To understand the etiology of community-acquired pneumonia(CAP) among hospitalized children in Zhongshan and to analyze its relation with climate parameters. Methods Total 13 705 children with CAP hospitalized in Zhongshan Boai Hospital from September 2014 to August 2016 were included in the study.Respiratory pathogenic microorganism in sputum, swabs, blood, and lveolar lavage were detected by indirect immunofluorescence(IFA), enzyme-linked immunosorbent assay(ELISA),the colloidal gold and bacterial culture. Results Out of 13 705 cases, 8 412 were positive for etiological testing with the positive rate of 61.38%.The top three were respiratory syncytial virus 2 660(19.41%), mycoplasma pneumoniae 2 195(16.02%) and hemophilies influenzae 1 798(13.12%).The coinfection rate was 34.27%.The infection rate of mycoplasma pneumoniae was different between male and female cases(χ~2=103.900, P<0.01).The positive rate of MP was significantly higher in summer and autumn than in spring and winter(χ~2=101.188,P<0.01);while,the positive rate of Flu virus was higher in spring(χ~2=123.415,P<0.01),RSV detection rate was significantly higher in the spring and winter(χ~2=317.574,P<0.01).The detection of mycoplasma pneumoniae and parainfluenza were positively correlated with the monthly average time of sunshine and the average temperature,while,the detection of Influenza virus was positively correlated with the monthly average humidity. Conclusions The detection rate of pathogenic microorganism varies among children with CAP in different age group and in different season as well.Respiratory syncytial virus plays the most important role in the pathogenic microorganisms of children with CAP,especially in spring and winter,Hemophilus influenzae is the leading infectious agent of CAP.in children.The infection rate of Mycoplasma pneumoniae in children increases in summer and autumn,especially during the elevation of monthly average sunshine time and temperature.
引文
[1] Walker CL,Rudan I,Liu L,et al.Global burden of childhood pneumonia and diarrhea[J].Lancet,2013,381(9875):1405-1416.
[2] 王芬,耿荣,钱素云,等.152 例社区获得性肺炎住院患儿的病原学分析[J].中华急诊医学杂志,2011,20(8):866-868.
[3] 李军,朱启镕.上海复旦大学附属儿科医院急性下呼吸道感染患儿常见病毒的检测及临床研究[J].微生物与感染,2006,1(4):217-222.
[4] 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.
[5] Liu L,Oza S,Hogan D,et al.Global,regional,and national causes of under-5 mortality in 2000-15:an updated systematic analysis with implications for the Sustainable Development Goals[J].Lancet,2016,388:3027-3035.
[6] Zhang RF,Jin Y,Xie ZP,et al.Human respiratory syncytial virus in children with acute respiratorytract infections in China[J].J Clin Microbiol,2010,48 (11):4193-4199.
[7] 丁小芳,张兵,钟礼立,等.100 例重症社区获得性肺炎住院儿童的病毒病原学分析[J].临床儿科杂志,2012,30(9):857-861.
[8] 冯英,罗征秀,符州,等.重庆地区婴幼儿社区获得性肺炎病原学分析[J].儿科药学杂志,2011,17(5):39-42.
[9] 林建生,饶灶鑫,施宗明.等.泉州地区 2013年八种呼吸道病原体流行特征及与气象因素关系分析[J/CD].临床检验杂志(电子版),2017,4(3):897-903.
[10] 陈正荣,季伟,王宇清,等.2006-2010 年苏州地区住院儿童急性呼吸道腺病毒感染与气候因素的相关性研究[J].临床儿科杂志,2012,30(6):539-541.
[11] 赵连爽,赵俊华,杜毅鑫,等.呼吸道感染患儿肺炎支原体抗体检测结果分析[J].中国公共卫生,2012,28(4):534-535.
[12] 吴倩,吴起武.儿童肺炎支原体感染流行病学的研究进展[J].中国妇幼保健,2016,31(5):1111-1114.
[13] Ma YJ,Wang SM,Cho YH,et al.Clinical and epidemiological characteristics in children with community-acquired mycoplasma pneumonia in Taiwan:A nationwide surveillance[J].J Microbiol Immunol Infect,2015,48(6):632-638.
[14] 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.
[15] 冯长松,李雪香,孙国强,等.2016 年儿科病区社区获得性肺炎病原谱分析[J].世界最新医学信息文摘,2017,17(100):217-219.
[16] Peng Y,Shu C,Fu Z,et al.Pathogen detection of 1 613 cases of hospitalized children with community acquired pneumonia[J].Zhongguo Dang Dai Er Ke Za Zhi,2015,17(11):1193-1199.
[17] 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.
[18] Chiu CY,Chen CJ,Wong KS,et al.Impact of bacterial and viral coinfection on mycoplasmal pneumonia in childhood community-acquired pneumonia[J].J Microbiol Immunol Infect,2015,48(1):51-56.
[19] 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):698-702.
[2] 王芬,耿荣,钱素云,等.152 例社区获得性肺炎住院患儿的病原学分析[J].中华急诊医学杂志,2011,20(8):866-868.
[3] 李军,朱启镕.上海复旦大学附属儿科医院急性下呼吸道感染患儿常见病毒的检测及临床研究[J].微生物与感染,2006,1(4):217-222.
[4] 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.
[5] Liu L,Oza S,Hogan D,et al.Global,regional,and national causes of under-5 mortality in 2000-15:an updated systematic analysis with implications for the Sustainable Development Goals[J].Lancet,2016,388:3027-3035.
[6] Zhang RF,Jin Y,Xie ZP,et al.Human respiratory syncytial virus in children with acute respiratorytract infections in China[J].J Clin Microbiol,2010,48 (11):4193-4199.
[7] 丁小芳,张兵,钟礼立,等.100 例重症社区获得性肺炎住院儿童的病毒病原学分析[J].临床儿科杂志,2012,30(9):857-861.
[8] 冯英,罗征秀,符州,等.重庆地区婴幼儿社区获得性肺炎病原学分析[J].儿科药学杂志,2011,17(5):39-42.
[9] 林建生,饶灶鑫,施宗明.等.泉州地区 2013年八种呼吸道病原体流行特征及与气象因素关系分析[J/CD].临床检验杂志(电子版),2017,4(3):897-903.
[10] 陈正荣,季伟,王宇清,等.2006-2010 年苏州地区住院儿童急性呼吸道腺病毒感染与气候因素的相关性研究[J].临床儿科杂志,2012,30(6):539-541.
[11] 赵连爽,赵俊华,杜毅鑫,等.呼吸道感染患儿肺炎支原体抗体检测结果分析[J].中国公共卫生,2012,28(4):534-535.
[12] 吴倩,吴起武.儿童肺炎支原体感染流行病学的研究进展[J].中国妇幼保健,2016,31(5):1111-1114.
[13] Ma YJ,Wang SM,Cho YH,et al.Clinical and epidemiological characteristics in children with community-acquired mycoplasma pneumonia in Taiwan:A nationwide surveillance[J].J Microbiol Immunol Infect,2015,48(6):632-638.
[14] 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.
[15] 冯长松,李雪香,孙国强,等.2016 年儿科病区社区获得性肺炎病原谱分析[J].世界最新医学信息文摘,2017,17(100):217-219.
[16] Peng Y,Shu C,Fu Z,et al.Pathogen detection of 1 613 cases of hospitalized children with community acquired pneumonia[J].Zhongguo Dang Dai Er Ke Za Zhi,2015,17(11):1193-1199.
[17] 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.
[18] Chiu CY,Chen CJ,Wong KS,et al.Impact of bacterial and viral coinfection on mycoplasmal pneumonia in childhood community-acquired pneumonia[J].J Microbiol Immunol Infect,2015,48(1):51-56.
[19] 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):698-702.