新生儿呼吸道合胞病毒肺炎182例临床及流行病学特点

Clinical and Epidemiological Features of Respiratory Syncytial Virus Pneumonia in 182 Neonates

目的探讨新生儿呼吸道合胞病毒(RSV)肺炎的临床及流行病学特点。方法收集本院2009年2月-2011年3月确诊为新生儿肺炎的患儿709例,应用直接免疫荧光法检测其RSV抗原,根据检测结果分为RSV阳性组和RSV阴性组,对2组患儿临床及流行病学资料进行分析。结果 1.RSV阳性182例,RSV检出高峰期为10月份-次年2月份。2.RSV阳性组:日龄≤7 d者占17.0%(31/182例),明显低于阴性组[26.0%(137/527例)](χ2=6.011,P=0.014);母乳喂养占40.7%(74/182例),明显低于阴性组[49.1%(259/527例)](χ2=3.912,P=0.048)。3.RSV阳性组较RSV阴性组显著增多的临床表现:咳嗽(χ2=86.957,P=0.000)、肺部中细湿啰音(χ2=17.504,P=0.000)及哮鸣音(χ2=25.293,P=0.000)。4.RSV与细菌混合感染113例(62.1%),合并感染的常见细菌依次为大肠埃希菌28例(15.4%),肺炎克雷伯菌25例(13.7%),金黄色葡萄球菌23例(12.6%),与RSV阴性组病原菌构成相似。5.RSV阳性组需氧疗的患儿占22.0%(40/182例),明显高于阴性组[9.3%(49/527例)](χ2=19.815,P=0.000);治愈好转出院的RSV阳性组患儿住院时间[(12.8±4.9)d,n=81]明显长于阴性组[(11.4±4.9)d,n=236](t=2.214,P=0.028)。结论 RSV是重庆地区秋冬季新生儿感染性肺炎的重要病原之一。新生儿的RSV易感性与特应性体质可能存在关联,母乳喂养可减少新生儿感染RSV的风险。RSV肺炎常合并细菌感染,此类患儿宜给予抗生素治疗。

Objective To explore the clinical and epidemiological features of neonatal respiratory syncytial virus （RSV） pneumonia Methods Seven hundred and nine cases of neonatal pneumonia were enrolled. Direct immunofluorescence assay was employed to detect RSV antigen in sputum. All the clinical data were collected and compared between RSV - positive group and RSV - negative group. Results 1. RSV positive samples were identified in 182 cases among the enrolled 709 cases （25.7%）. Prevalence rates of RSV pneumonia reached at the peak during Oct. to Feb. next year. 2. The percentage of neonates younger than 7 d in RSV - positive group was 17.0% （31/182 cases）, which was significantly lower than that in RSV - negative group [ 26.0% （ 137/527 cases） ] （χ^2 = 6.011,P = 0.014 ）. The breastfeeding rate in RSV - positive group was 40.7% （74/182 cases） ,which was significantly lower than that in RSV - negative group [49.1% （259/527 cases） ] （χ^2= 3. 912 ,P = 0.048 ）. 3. In terms of clinical manifestations, cough （χ^2= 86.957, P = 0.000 ）, fine moist rales （χ^2= 17. 504, P = 0.000） and wheeze （χ^2 = 25. 293, P = 0.000 ） in RSV - positive group were statistically higher than those in RSV - negative group. 4. In RSV -positive group, 113 cases （62.1% ） were co -infected with bacteria, including escherichia coli in 28 cases （15.4%） ,klebsiella pneumoniae in 25 cases （ 13.7% ） ,and staphylococcus aureus in 23 cases （ 12.6% ）. The constituent ratio of bacteria in RSV - positive group was similar to that in RSV - positive group. 5. Compared with RSV - negative group, RSV - positive group had more oxygen use （ 22.0% vs 9.3 % ; χ^2= 19.815, P = 0. 000 ）, and longer duration of hospitalization [ （ 12.8 ±4.9 ） d vs （ 11.4 ±4.9 ） d ; t = 2.214,P = 0.028 ]. Conclu- sions RSV is one of the important pathogens of neonatal pneumonia during autumn and winter in Chongqing area. Breastfeeding can decrease the infants＇ susceptibility to RSV infection. Neonates with RSV pneumonia are prone to have concurrent bacterial infection, and antibiotics shall be included in the empirical therapy.