婴幼儿轮状病毒腹泻并发肠道菌群失调状态的探讨

Rotavirus diarrhea complicated by alteration of intestinal flora in infants

目的探讨婴幼儿轮状病毒(RV)腹泻并发肠道菌群失调的相关性,为临床医师诊断疾病及合理用药提供实验室依据。方法采用胶体金法检测RV抗原;按照《全国临床检验操作规程》,采集粪便标本进行细菌培养和沙门菌属、志贺菌属及致病菌性大肠埃希菌等腹泻致病菌的菌种鉴定,同时对肠道菌群失调状态进行分析。结果采集婴幼儿腹泻病例377例,其中RV阳性组125例,占33.2%;有23例发生肠道菌群失调,发生率为6.1%,在出现肠道菌群失调状态的患儿中,<1岁婴幼儿有14例,占60.9%,>1岁有9例,占39.1%;RV阳性组发生肠道菌群失调9例,发生率为7.2%;RV阴性组发生肠道菌群失调14例,发生率为5.6%,阳性组的发生率高于阴性组(χ2=4.979,P=0.0252)。结论 RV阳性组和<1岁婴幼儿肠道菌群失调发生率更高,建议临床医师对婴幼儿腹泻,包括轮状病毒肠炎患儿,应常规进行粪便细菌培养,以早期发现肠道菌群失调状态,避免造成婴幼儿腹泻预后不良。

OBJECTIVE To investigate the correlation between the rotavirus diarrhea and alteration of intestinal flora in infants to provide laboratory evidence for clinicians to diagnose disease and rational drug use. METHODS The rotavirus antigen was detected by colloidal gold methods. Referring to National Guide to Clinical Laboratory Procedures, stool specimen was collected to perform bacterial culture and strain identification of Salmonella, Shi- gella, pathogenic Escherichia coli and other diarrheal pathogens. At the same time the state of the intestinal flora was analyzed. RESULTS Among 377 cases of infantile diarrhea cases including 125 （33.2%） cases in RV-positive group, there were 23 cases with alteration of intestinal flora with incidence of 6. 1%, among which 14 cases （60.9%） were the age less than one year, 9 cases （39.1%） were the age more than 1 yearl in the RV-positive group, there were 9 cases with maladjustment of intestinal flora with the incidence of 7. 2% ~ and in the RV- negative group there were 14 cases with the incidence of 5.6% ,the incidence rate was higher in the positive group than in the negative group（X^2 = 4. 979, P= 0. 0252）. CONCLUSION The incidence of maladjustment of intestinal flora is relatively higher in the RV-positive infants and the infants with age less than one year, it is suggested that the clinician should routinely perform the bacteria culture for the stool of the diarrhea infants including the infants with rotavirus enteritis in order to detect early alteration of intestinal flora and avoid the poor prognosis of infantile diarrhea.