毛细支气管炎患儿鼻咽部定植菌临床意义探讨

Clinical significance of nasopharyngeal bacterial colonization in children with acute bronchiolitis

目的探讨鼻咽部定植菌对呼吸道合胞病毒（RSV）毛细支气管炎的影响。方法选取因急性毛细支气管炎而住院的儿童211例为研究对象，采用无菌负压抽取痰液法检测鼻咽部病原菌及肺炎支原体特异性抗体。以外科手术患儿为对照组，比较两组患儿定植菌分布情况。同时对定植菌阳性的RSV患儿与阴性者的临床和实验室指标做比较。结果对照组鼻咽部定植菌阳性率高达74．1％（292／394），明显高于RSV毛细支气管炎患儿的55．0％（116／211）（P〈0．01）。定植菌阳性的RSV毛细支气管炎患儿的重症毛细支气管炎的比例高于定植菌阴性RSV患儿（13．8％比4．2％，P=0．018），更易出现呼气困难（19．8％比9．5％，P=0．037），且住院时间也略长（8．2d比7．5d，P=0．036），CRP升高的比例要明显高于后者（17．2％比4．2％，P=0．003）。结论鼻咽部定植菌可作为临床重症RSV毛细支气管炎的预测指标。

Objectives To explore the effects of nasopharyngeal bacterial colonization in chihtren with acute bronchiolitis due to respiratory syncytial virus （RSV）. Methods Hospitalized children of acute bronchiolitis were enrolled to detect pathogen and bacterial colonization. Their clinical data and laboratory results were collected and analyzed. Cases of elective surgery were also obtained as control group. Results Fifty-five percent of all children with bronchiolitis had a lower positive rate of nasopharyngeal bacterial culture （55.0% vs. 74. 1% , P 〈0.01 ）. Children with nasopharyngeal bacterial colonization had a higher rate of severe bronchiolitis （ 13.8% vs. 4. 2% , P ： 0. 018 ） , presented dyspnea more frequently （ 19.8% vs. 9.5%, P =0. 037） and had a longer hospital duration （8.2 vs. 7.5 days, P =0. 036） as compared with those without bacterial colonization. In terms of laboratory results, a higher proportion of C-reactive protein was found in children with bacterial colonization than those with non-bacterial colonizations （ 17.2% vs. 4. 2% , P = 0. 003 ）. Conclusion Bacterial colonization may be a predictor for severe bronchiolitis.