石家庄市有呼吸道症状的不明原因发热病人呼吸道样本病原检测结果分析

Analysis of pathogen detection results of upper respiratory tract specimens from fever clinic patients

目的探讨有呼吸道症状的不明原因发热病人呼吸道样本病原构成及分布特点。方法收集2020年1-4月石家庄地区四家二级以上医院(河北省中医院、栾城区人民医院、鹿泉区人民医院、深泽县医院)就诊的96例有呼吸道症状的不明原因发热病人的呼吸道样本,采用多重荧光聚合酶链式反应(PCR)方法进行甲型流感病毒、乙型流感病毒、肠道病毒、副流感病毒Ⅰ型/Ⅱ型/Ⅲ型/IV型、呼吸道腺病毒、人偏肺病毒、呼吸道合胞病毒、人鼻病毒、人博卡病毒、2019新型冠状病毒、肺炎支原体、肺炎衣原体、嗜肺军团菌、铜绿假单胞菌、肺炎链球菌、肺炎克雷伯菌、A组链球菌、流感嗜血杆菌、金黄色葡萄球菌核酸检测,结果进行卡方分析。结果96例发热病人呼吸道样本中共检出8种病原,其中包括1种病毒、6种细菌和肺炎支原体。流感病毒、副流感病毒等12种病毒、嗜肺军团菌和肺炎衣原体等均未检出。病原检出率由高到底依次为肺炎链球菌(58/96,60.42%)、流感嗜血杆菌(38/96,39.58%)、肺炎克雷伯菌(14/96,14.58%)、金黄色葡萄球菌(10/96,10.42%)、肺炎支原体(8/96,8.33%)、铜绿假单胞菌(6/96,6.25%)、A组链球菌(4/96,4.17%)、人鼻病毒(2/96,2.08%)。发热病人单一病原感染和多病原混合感染占比相近,分别为41.67%(40/96)和45.83%(44/96),有12.50%(12/96)的病例未检出病原。女性发热病人肺炎支原体的感染率(21.43%)高于男性(2.94%),差异有统计学意义(P<0.05)。其余病原在不同性别和年龄组分布中差异无统计学意义(P>0.05)。结论石家庄市2020年有呼吸道症状的发热病人上呼吸道病原以细菌感染为主,偶有鼻病毒和肺炎支原体感染,临床诊疗时,应结合病原学结果综合考虑。

Objective To explore the pathogen composition and distribution characteristics of pathogens in respiratory samples from patients with fever of unknown origin.Methods Atotal of 96 respiratory samples of patients with unknown cause fever with respiratory symptoms were collected from four hospitals above grade II in Shijiazhuang area(Hebei Provincial Hospital of Traditional Chinese Medicine,Luancheng District People’s Hospital,Luquan District People’s Hospital,Shenze County Hospital)from January to April 2020,and multiplex-fluorescent polymerase chain reaction(PCR)was used to detect influenza A virus,influenza B virus,enterovirus,parainfluenza virusⅠ/Ⅱ/Ⅲ/Ⅳ,respiratory adenovirus,human metapneumovirus,respiratory syncytial virus,human rhinovirus,human bocavirus,COVID-19,Mycoplasma pneumoniae,Chlamydia pneumoniae,Legionella pneumophila,Pseudomonas aeruginosa,Streptococcus pneumoniae,Klebsiella pneumoniae,Group A streptococcus,Haemophilus influenzae,Staphylococcus aureus nucleic acid detection,the results were analyzed for chi-square.Results A total of 8 pathogens were detected in the upper respiratory tract samples of 96 fever patients,including 1 kind of virus,6 kinds of bacterias,and Mycoplasma pneumoniae.There were12 viruses including influenza virus and parainfluenza virus,Legionella pneumophila and Chlamydia pneumoniae were not detected.The pathogen detection rates in descending order were Streptococcus pneumoniae(58/96,60.42%),Haemophilus influenzae(38/96,39.58%),Klebsiella pneumoniae(14/96,14.58%),Staphylococcus aureus(10/96,10.42%),Mycoplasma pneumoniae(8/96,8.33%),Pseudomonas aeruginosa(6/96,6.25%),Group A streptococcus(4/96,4.17%)and human rhinovirus(2/96,2.08%).The proportions of single-pathogen infection and multi-pathogen mixed infection in fever clinic patients were similar,41.67%(40/96)and 45.83%(44/96),respectively,and 12.50%(12/96)of the cases had no pathogens detected.The infection rate of Mycoplasma pneumoniae in female patients with fever(21.43%)was higher than that in male patients with fever(2.94%)(P<0.05).There was no statistical difference between the distribution of of other pathogens and gender and age(P>0.05).Conclusion sThe upper respiratory tract pathogens were mainly bacterial infections,and occasional human rhinovirus and Mycoplasma pneumonia infections.In clinical diagnosis and treatment,comprehensive consideration should be given to the pathogen detection.