儿童社区获得性肺炎流行病学特点及血清降钙素原水平临床分析

Clinical analysis of epidemiological characteristics of community-acquired pneumonia and level of serum procalciton in children

目的探讨儿童社区获得性肺炎(CAP)流行病学特点及血清降钙素原在肺炎早期诊断和治疗中的价值。方法选择医院2011年1月-2012年5月CAP患儿246例,对患者的年龄分布、发病季节、原发疾病进行分析,并检测血清降钙素原(PCT)、C反应蛋白(CRP)水平。结果 246例儿童CAP患者年龄主要以<1岁居多,秋冬季发病高于春夏季,主要原发疾病为先心病、血液病、神经系统疾病、早产低体重儿、肾病综合征等;246例CAP患儿经痰培养检出细菌性肺炎患儿162例,非细菌性肺炎患儿84例,细菌性肺炎患儿血清PCT、CRP水平明显高于非细菌性肺炎患儿,差异有统计学意义(P<0.05);住院第1天PCT检测阳性率83.33%,第7天PCT阳性率下降为30.25%,差异有统计学意义(P<0.05);重症肺炎PCT阳性率明显高于普通肺炎。结论儿童社区获得性肺炎主要出现在年龄较小儿童,秋冬季易发病,血清PCT、CRP水平与细菌感染密切相关,PCT、CRP检测可评估病情的轻重程度,对指导临床治疗具有重要参考意义。

OBJECTIVE To explore the epidemiological characteristics of community-acquired pneumonia （CAP） in children and to analyze the value of serum proealcitonin （PCT）level in the early diagnosis and treatment of pneumonia. METHODS A total of 246 children with CAP, who enrolled the hospital from Jan. 2011 to May 2012, were selected as the study objects. The age distribution of patients, onset seasons and primary disease were analyzed, and the levels of serum PCT and the C-reactive protein （CRP） levels were detected. RESULTS Of totally 246 children investigated, most of the children were under 1 year old. The incidence of the disease in autumn and winter was higher than that in spring and summer. The main primary diseases were congenital heart disease, hematologic disease, nervous system disease, premature birth children and nephrotic syndrome. Of 246 cases of CAP, 162 cases suffered from bacterial pneumonia, 84 cases with non-bacterial pneumonia. The levels of serum PCT and CRP in the children with bacterial pneumonia were significantly higher than that in the children with nonbacterial pneumonia, the difference was staitistically significant （P〈0.05）. The positive rate of PCT was 83.33% on the 1st day of enrollment, decreasing to 30.25% on the 7th day, the difference was statistically significant（P〈 0.05） ; the positive rate of PCT of the children with severe pneumonia was significantly higher than that of the children with ordinary pneumonia. CONCLUSION The CAP mainly occurred in the children with young age, with its peak in autumn and winter. The levels of serum PCT and CRP are closely related to the bacterial infections. The detection of PCT and CRP is valuable to assess the severity of the disease, which is of clinical significance to the treatment of the disease.