某基层医院与三甲儿童医院儿童呼吸道感染病原谱比较

Comparison of pathogen spectrums among children with respiratory tract infection between a primary and a grade⁃A tertiary children's hospital

目的 比较分级诊疗下某基层医院和三甲儿童医院的儿童急性呼吸道感染病原谱差异。方法 收集2021年11月至2022年3月北京某基层医院及某三甲儿童医院临床诊断为急性呼吸道感染患儿的呼吸道标本,采用多重逆转录-聚合酶联反应(RT-PCR)与毛细电泳联用技术检测13种呼吸道病原,统计学方法分析两家医院急性呼吸道感染儿童病原谱差异。结果 基层医院纳入患儿112例,男女比例为1∶1,呼吸道病原总阳性检出率为71.43%(80/112),单种病原感染72例(64.29%,72/112),混合感染8例(7.14%,8/112,均为2种病原);三甲儿童医院纳入患儿115例,男女比例1.02∶1,呼吸道病原总阳性检出率为70.43%(81/115),单种病原感染66例(57.39%,66/115),混合感染15例(包括2种病原感染12例,10.43%,12/115;3种病原感染3例,2.61%,3/115)。0~3岁婴幼儿中,基层医院与三甲儿童医院HMPV阳性检出率(52.9%,9/17;5.3%,4/75)差异有统计学意义(χ^(2)=38.10,P<0.05);三甲儿童医院儿童RSV阳性检出率(44.0%,33/75)高于基层医院(23.5%,4/17),但差异无统计学意义(χ^(2)=2.415,P>0.05)。4~15岁儿童中,基层医院Flu B阳性检出率为31.58%(30/95),三甲儿童医院为20.0%(8/40),差异有统计学意义(χ^(2)=6.96,P<0.05);三甲儿童医院MP阳性检出率为37.5%(15/40),基层医院未检出,差异有统计学意义(χ^(2)=40.08,P<0.05)。结论 2021-2022年冬春季节北京某基层医院与三甲儿童医院的儿童呼吸道感染病原谱构成存在差异,各年龄段病原谱分布也不同,提示分级诊疗以及基层医院开展核酸检测的必要性。

Objective To compare the pathogen spectrums among children with acute respiratory tract infection between a primary and a grade-A tertiary children's hospital under hierarchical diagnosis and treatment.Methods From November 2021 to March 2022,children who visited either a primary hospital or a grade-A tertiary children's hospital and were diagnosed with acute respiratory tract infections were selected for respiratory tract pathogen screening using multiple RT-PCR and capillary electrophoresis.The spectrum of pathogen was compared between these hospitals using the statistical software SPSS 23.0.Results A total of 112 cases were enrolled from the primary hospital,with a male to female ratio of 1∶1.Out of these cases,71.43%(80/112)were found to have respiratory pathogens.Among them,72 cases were infected by one pathogen(64.29%,72/112)and 8 cases were co-infected by two pathogens(7.14%,8/112).In this group,70.43%(81/115)were found to have respiratory pathogens,Out of these cases,66 were infected by one pathogen(57.39%,66/115).12 cases were co-infected by two pathogens(10.43%,12/115),and 3 cases were infected by three pathogens(2.61%,3/115).In children aged 0-3 years,the positive rate of HMPV showed a significant dif-ference(χ^(2)=38.10,P<0.05)between the primary hospital(52.9%,9/17)and the grade-A tertiary children's hos-pital(5.3%,4/75).The positive rate of RSV was higher in the grade-A tertiary children's hospital(44.0%,33/75)compared to the primary hospital(23.5%,4/17),but showed no significant difference(χ^(2)=2.415,P>0.05).For children aged 4-15 years,significant differences were observed in the positive rate of Flu B(31.58%,30/95 in the primary hospital;20.0%,8/40 in the grade-A tertiary children's hospital)(χ^(2)=6.96,P<0.05)and MP(37.5%,15/40 in the grade-A tertiary children’s hospital;zero in the primary hospital)(χ^(2)=40.08,P<0.05).Conclusion During the winter and spring of 2021-2022,the composition of pathogenic spectrum in acute respiratory tract in-fections in children varied between a primary and a grade-A tertiary children's hospital in Beijing.This difference was also observed across different age groups.These findings suggest the importance of implementing hierarchical diagnosis and treatment,as well as nucleic acid testing in primary hospitals.