急性呼吸道感染患儿前期病毒或支原体感染与鼻咽部定植菌之间的时间相关性

Correlation between preceding respiratory virus or Mycoplasma pneumoniae infections and nasopharyngeal colonization in children with acute respiratory tract infection

目的 探讨急性呼吸道感染患儿前期病毒或肺炎支原体（MP）感染与鼻咽部定植菌之间的时间相关性.方法 选取2006年1月至2010年12月因急性呼吸道感染（ARI）在苏州大学附属儿章医院住院治疗的忠儿作为研究对象,共8 322例.同时采集忠儿鼻咽部分泌物及血清标本进行多病原检测.应用直接免疫荧光法检测鼻咽分泌物中呼吸道合胞病毒（RSV）、流感病毒A（Ⅳ-A）和流感病毒B（Ⅳ-B）、副流感病毒1～3型、腺病毒（ADV）;荧光定量聚合酶链反应检测鼻咽分泌物中MP;反转录-聚合酶链反应检测人类偏肺病毒（hMPV）;痰培养检测定植菌;定量酶联免疫吸附法检测MP特异性抗体.分析常见呼吸道病原与定植菌之间的时间相关性以及滞后效应.结果 同期（滞后0个月）,仅RSV与卡他莫拉菌之间存在显著相关性（rs=0.270,P=0.035）,且滞后1个月时二者仍存在显著相关性（rs=0.290,P=0.024）.滞后1个月时,RSV（rs=0.370,P=0.004）和hMPV（rs=0.350,P=0.006）与流感嗜血杆菌存在相关性,且RSV的此种相关性在滞后2个月时增强.Ⅳ-A与肺炎链球菌在滞后1个月时存在显著负相关性（rs=-0.339,P=0.009）;滞后1个月,ADV与肺炎链球菌也存在显著负相关性（rs=-0.269,P=0.040）;同时ADV与卡他莫拉菌也存在显著负相关（rs=-0.300,P=0.021）,且此种相关性在滞后2个月时显著增强（r=-0.380,P=0.003）.结论 住院儿童病毒或MP流行活性与鼻咽部定植菌之间存在一定的时间相关性,而且RSV、hMPV、Ⅳ-A、ADV、MP与定植菌存在滞后效应.

Objective To elucidate the correlation between preceding respiratory virus or Mycoplasma pneumoniae （MP） infections and bacterial colonnization of the nasopharynx.Methods A total of 8 322 children hospitalized with acute respiratory tract infection from Jan.2006 to Dec.2010 in Chiidren＇s Hospital Affiliated to Soochow Uriversity were enrolled.Nasopharyngeal aspiration fluid and serum samples were collected and sent for multi-pathogen detection.Respiratory syncytial virus （RSV）,influenza virus type A （Ⅳ-A） and influenza virus type B （Ⅳ-B）,parainfluenza virus type 1-3 （PIV 1-3） and Adenovirus （ADV） were detected by direct immunofluorescence assay.MP were detected by polymerase chain reaction （PCR） while human metapneumovirus （hMPV） was detected by reverse transcription polymerase chain reaction.Sputum culture was used to detect bacterial colonization and qpantitative enzyme linked immunosorbent assay was used to detect specific antibodies of MP.Correlations between preceding respiratory virus or MP infections and bacterial colonization were analyzed using Spearman correlation coefficient.Results At time 0 month,only Moraxella catarrhalis was significantly correlaed with RSV （rs =0.270,P =0.035） and the correlation increased slightly at 1 month lag （rs =0.290,P =0.024）.There was significant correlation between RSV （rs =0.370,P =0.004） or hMPV （rs =0.350,P =0.006） and hemophilus influenza at 1 month lag with a stronger correlation at 2 months lag.For Ⅳ-A,there was negative correlation with Streptococcus pneumoniae at 1 month lag （rs =-0.339,P =0.009） as well as there was negative correlation between ADV and Streptococcus pneumoniae （rs =-0.269,P =0.040）.At 1 month lag,negative correlation was present between ADV and Moraxella catarrhalis （rs =-0.300,P =0.021） and the correlation was stronger at 2 month lag （rs =-0.380,P =0.003）.Conclusions To some extent,there are temporal associations between preceding respiratory virus and MP infections and nasopharyngeal colonization,furt hermore lag effect was found between RSV,hMPV,Ⅳ-A,ADV,MP and bacterial colonization.