呼吸道合胞病毒下呼吸道感染与患儿鼻咽部定植菌群的关系

The relationship between RSV lower respiratory tract infection and nasopharyngeal microbiome

目的研究鼻咽部定植菌群与呼吸道合胞病毒(RSV)下呼吸道感染患儿病情特点的关系,从微生态角度寻找预防或治疗RSV下呼吸道感染的理论依据。方法回顾性分析我院2020年8月1日到2021年10月31日收治的RSV下呼吸道感染患儿,根据鼻咽部分泌物培养结果分为阴性组、阳性组,对比两组患儿临床特点及潮气肺功能检测结果。结果1090例RSV下呼吸道感染患儿中培养阳性者290例(26.58%),中位数年龄为8个月(3.24个月,14个月)。各年龄层患儿鼻咽部菌群定植率及定植菌群差异有统计学意义(均P>0.05)。各年龄层患儿鼻咽部定植菌均以肺炎链球菌为主。金黄色葡萄球菌、大肠埃希菌及卡他莫拉菌定植的患儿发热率较低。与喘息相关定植菌为肺炎链球菌、流感嗜血杆菌及金黄色葡萄球菌。与重症相关的定植菌为肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌、大肠埃希菌。与大叶性肺炎发生相关的只有肺炎链球菌。肺炎链球菌及流感嗜血杆菌定植的达峰容积比(Z=-4.12,P<0.001;Z=-1.99,P=0.046)与达峰时间比(Z=-4.24,P<0.001;Z=-1.98,P=0.047)均低于阴性组。结论特定鼻咽部定植菌的存在会影响RSV下呼吸道感染患儿的临床表现,同时降低婴幼儿潮气肺功能检测结果。

Objective To explore the relationship between nasopharyngeal microbiome and RSV lower respiratory tract infection(RSV-LRTI),and find theoretical basis for the prevention or treatment of RSV infection from view of microecology.Methods The patients with RSV-LRTI in our hospital from August 1,2020 to Oct 31,2021 were retrospectively analyzed.According to the results of nasopharyngeal swab culture,they were divided into negative group and positive group.The clinical characteristics and tidal pulmonary function were compared between groups.Results Among 1,090children with RSV-LRTI,290 cases(26.58%)were in positive group.The median age was 8 months(3.24 months,14months).There were statistically significant differences in nasopharyngeal colonization rate and colonization flora among different age groups.Streptococcus pneumoniae was predominant in all age groups.The fever rate of children with S.aureus,Escherichia coli or Catalmorella was lower.The colonizing bacteria associated with wheezing were Streptococcus pneumoniae,Haemophilus influenzae and S.aureus.Streptococcus pneumoniae,Haemophilus influenzae,Staphylococcus aureus,and Escherichia coli were related to disease severity.Only Streptococcus pneumoniae was associated with lobar pneumonia.The peak volume ratio(Z=-4.12,P<0.001;Z=-1.99,P=0.046)and peak time ratio(Z=-4.24,P<0.001;Z=-1.98,P=0.047)of Streptococcus pneumoniae and Haemophilus influenzae were lower than those in negative group.Conclusion The presence of specific nasopharynx colonizing bacteria will affect the clinical manifestations of RSV lower respiratory tract infection and reduce the results of tidal lung function in infants.