儿童B型流感病毒肺炎的混合感染调查

The investigation of co-infection in pediatric pneumonia with influenza virus B

目的:探讨儿童B型流感病毒(IVB)肺炎的混合感染情况。方法:收集IVB肺炎患儿94例的临床资料,分析其混合感染率、混合感染病原谱及其影响。用直接免疫荧光法(DFA)检测脱落细胞内相关病毒,用PCR方法测定呼吸道分泌物博卡病毒和人类偏肺病毒核酸,采用酶联免疫吸附试验(ELISA)检测血清肺炎支原体IgG、IgM抗体。结果:⑴IVB肺炎患儿94例中,混合感染67例(71.28%)。⑵混合单一其他病原感染47例(70.15%);其中细菌感染28例(41.79%)、病毒感染11例(16.42%)、肺炎支原体感染8例(11.94%)。⑶混合细菌感染46例(68.66%),具体分布依次为:肺炎链球菌24例(52.17%),流感噬血杆菌8例(17.39%),卡他布拉汉菌8例(17.39%),金黄色葡萄球菌3例(6.52%),大肠埃希菌2例(4.35%),琼氏不动杆菌1例(2.17%)。⑷混合其他病毒感染20例(29.85%),具体分布为:呼吸道合胞病毒16例(80%),博卡病毒3例(15%),人类偏肺病毒1例(5%)。⑸混合IVB感染组白细胞计数显著高于单纯IVB感染组(P<0.05)。混合IVB感染组的平均年龄和基础疾病携带率分别低于和高于单纯IVB感染组,但差异无统计学意义(P>0.05)。⑹单纯IVB肺炎组与混合感染组的细胞免疫指标比较差异无统计学意义(P>0.05)。结论:儿童IVB肺炎混合感染率高;混合其他单一病原感染为主,细菌占多数,其次为病毒和肺炎支原体;年龄小和基础疾病携带者可能更易发生混合感染。不论是否存在混合感染,儿童IVB肺炎预后基本良好。

Objective：To explore the co-infection of influenza virus B in pediatric pneumonia. Methods：Analysis was performed on the clinical data of IVB-infected pneumonia children who received therapy in Children＇s Hospital Affili-ated to Soochow University from December of 2011 to February of 2012 to summarize the co-infection rate of IVB, pathogen spectrum of co-infection and the effect of co-infection. Results： ⑴The co-infection rate of IVB in pediatric pneumonia was 71.28%（67/94）. ⑵The co-infection rate with another single pathogen was 70.15%（47/67）;including co-in-fection rate with single bacterial pathogen which was 41.79%（28/67）, co-infection rate with single viral pathogen which was 16.42%（11/67）,and co-infection rate with single mycoplasma pneumoniae which was 11.94%（8/67）. ⑶The rate of bacterial co-infection was 68.66%（46/67）; the concrete bacteria pathogen spectrum was： Streptococcus pneumoniae （SP, 52.17%,24/46）, Haemophilus influenzae （HI,17.39%,8/46）, Moraxella catarrhal （MC,17.39%,8/46）, Staphylococcus aureus （SA, 6.52%,3/46）, Escherichia coil（E.coil,4.35%,2/46） and Joan＇s acinetobacter（2.17%,1/46）.⑷The rate of other virus co-infections were 29.85%（20/67）, the concrete virus pathogen spectrum was： respiratory syncytial virus（RSV,80%,16/20）, hu-man boca virus（15%,3/20） and human metapneumovirus （5%,1/20）.⑸The white cell counts of the co-infected IVB pneu-monia group was significantly higher than that of the single IVB pneumonia group （P〈0.05）. There was no statistical dis-tinction between the two groups for other indicators such as inpatient days, days with fever, the proportion of neutrophil leucocyte, CRP, prealbumin（PA）, AST, Cr, CKMB and ICU experience. The average age in the co-infection IVB pneumonia group was lower than that in the single IVB pneumonia group, and the underlying disease carrying rate of the co-infection IVB pneumonia group was higher than that of the single IVB pneumonia group; but there was no statistical distinction be-tween the two groups in age and underlying disease carrying rate. ⑹No significant difference was found between the single IVB pneumonia group and the co-infected IVB pneumonia group in cellular and humoral immunity indexes. Conclusions：The co-infection rate in pediatric pneumonia with IVB was high; single pathogen co-infection was dominant, with bacteria being in the majority, followed by other viruses and mycoplasma pneumoniae; the rate of co-infected with bacteria was high, the prominent bacterial pathogen was SP, followed by HI and MC; the main virus pathogens were RSV and human boca virus. Maybe co- infection was suseptible to smaller age children and underlying disease carriers. Regardless of the existence of co-infection, pediatric pneumonia with IVB had a good prognosis.