喘息性疾病患儿非细菌性病原体感染分析

Analysis of non-bacterial respiratory pathogen infection in children with asthmatic diseases

目的探讨呼吸道非细菌性病原体与婴幼儿喘息性疾病的相关性,以及血清总IgE水平和外周血中嗜酸性粒细胞计数在其感染中的临床意义。方法对2010年9月至2011年9月住院治疗的490例喘息性疾病患儿,采用间接免疫荧光法检测血清中9种呼吸道感染非细菌性病原体IgM抗体并进行病原学分析,并同时检测血清中总IgE水平和外周血中嗜酸性粒细胞计数。结果 490例喘息性疾病患儿中,检测出非细菌性病原体IgM抗体阳性233例,阳性率为47.6%,其中肺炎支原体(MP)的阳性率最高(25.3%),其次为腺病毒(ADV)(8.9%)和乙型流感病毒(FluB)(8.8%)。36例患儿同时检测出两种以上非细菌性病原体,且主要为MP与其他病原体的混合感染(94%)。各年龄组(0 d～、1个月～、6个月～、1岁～、3～8.9岁)IgM抗体的总检出率分别为50.0%、67.3%、33.1%、57.3%、61.7%,各组间差异有统计学意义(P<0.05)。支气管哮喘的呼吸道感染病原体IgM抗体检出率最高,其次为喘息性支气管炎,最低为毛细支气管炎。病原体检出阳性的患儿,血中嗜酸性粒细胞的数目明显减少,而血清总IgE水平显著升高。结论喘息性疾病患儿的非细菌性病原体主要是MP、ADV和FluB;MP和其他非细菌性病原体的混合感染比较普遍;1～6个月婴幼儿感染率较高;监测总IgE水平及嗜酸性粒细胞计数的变化对于婴幼儿喘息性疾病临床诊断和治疗有重大意义。

Objective To investigate the association of non-bacterial respiratory pathogens with asthmatic diseases in children,and the clinical significance of total serum IgE levels and peripheral eosinophil count in infection with non-bacterial respiratory pathogens.Methods Indirect immunofluorescence assay was used to detect IgM antibodies against nine types of non-bacterial respiratory pathogens in the sera of 490 children with asthmatic diseases between September 2010 and September 2011.Pathogens were analyzed and total serum IgE levels and peripheral eosinophil count were measured in IgM-positive cases.Results Of the 490 children with asthmatic diseases,47.6%（233 cases） were positive with IgM antibodies against non-bacterial respiratory pathogens,the most common being Mycoplasma pneumoniae（MP）（25.3%）,followed by adenovirus（ADV）（8.9%） and influenza B virus（Flu B）（8.8%）.Thirty-six cases suffered from co-infection of two or more non-bacterial pathogens,mainly comprising MP and other pathogens（94%）.There were significant differences in the total detection rate of IgM antibodies among all age groups（0-30 days： 50.0%;1-6 months： 67.3%;0.5-1 year： 33.1%;1-3 years： 57.3%;3-8.9 years： 61.7%）.The positive rate of IgM antibodies against respiratory pathogens was highest in children with bronchial asthma,followed by children with asthmatic bronchitis,and it was lowest in children with bronchiolitis.IgM-positive children had significantly decreased blood eosinophils and significantly increased total serum IgE levels.Conclusions The main non-bacterial respiratory pathogens include MP,ADV and Flu B in children with asthmatic diseases,and co-infection of MP and other non-bacterial pathogens is common.Infants aged 1 to 6 months have a higher infection rate than other age groups.Monitoring the changes in total serum IgE levels and peripheral eosinophil count has great significance for the clinical diagnosis and treatment of asthmatic diseases in children.