比较鼻咽抽吸物和支气管肺泡灌洗液对不同类型及不同年龄肺炎患儿诊疗的意义

A comparative study of nasopharyngeal aspirates and bronchoalveolar lavage fluid for diagnosis and treatment of pneumonia with different types and ages in children

目的 对不同类型及年龄肺炎儿童鼻咽抽吸物（NPA）和支气管肺泡灌洗液（BALF）的病原学比较研究。方法 苏州大学附属儿童医院210例肺炎患儿按不同年龄分为婴儿期、幼儿期、学龄前期、学龄期4组，按不同类型分为支气管肺炎及大叶性肺炎2组，收集 NPA 及 BALF进行多病原联合检测，分析不同类型及年龄肺炎患儿上下呼吸道吸出物病原检出情况。结果 支气管肺炎组及大叶性肺炎组BALF中肺炎支原体（MP）检出率［56.8%（42/74例）、89.0%（121/136例）］均高于 NPA［18.9%（14/74例）、72.1%（98/136例）］（χ^2=22.522、12.397，P 均 〈0.01）。支气管肺炎组 BALF中 MP检出率（56.8%）高于细菌［18.9%（14/74例）］和病毒［18.9%（14/74例）］，而大叶性肺炎组NPA 和 BALF中 MP检出率（72.1% 、89.0%）均高于细菌［7.4%（10/136例），2.9%（4/136例）］和病毒［15.4%（21/136例）、11.0%（15/136例）］（χ^2= 31.350、156.371、272.355，P均〈0.01）。大叶性肺炎组NPA和BALF中MP检出率（72.1% 、89.0%）均高于支气管肺炎组（18.9% 、56.8%），而支气管肺炎组NPA和BALF中细菌检出率［24.3%（18/74例），18.9% ］高于大叶性肺炎组（7.4% 、2.9%）（χ^2=54.374、28.628、11.945、15.612，P均 〈0.01）。支气管肺炎组 NPA 病毒检出率［33.8%（25/74例）］高于大叶性肺炎组（15.4%）（χ^2=9.426，P 〈0.01）。各年龄组BALF-MP检出率均较NPA高（χ^2=8.125，P 〈0.01；χ^2=5.475，P 〈0.05；χ^2=9.543，P 〈0.01；χ^2=7.175，P 〈0.05）。婴幼儿组 BALF中MP检出率高于细菌和病毒（χ^2=16.402，P 〈0.01）；学龄前期及学龄期儿童组NPA和BALF中MP检出率均高于细菌和病毒（χ^2=55.203、138.765、63.256、108.117，P均 〈0.01）。结论 大叶性肺炎及年长儿童肺炎病原体在NPA检出阳性率高，对部分治疗困难而又无法获得明确病原学资料的支气管肺炎及小年龄组肺炎患儿，可以考虑行BALF检测病原体。

Objective To compare the etiology of pneumonia between nasopharyngeal aspirates （NPA） or bronchoalveolar lavage fluid （BALF） in children. Methods Multiple pathogenic detection of NPA and BALF was performed in 210 cases with pneumonia in Children＇s Hospital Affiliated to Soochow University. According to the ages, the children were divided into 4 groups ：infancy, early childhood, preschool and school - age. According to the types the cases were divided into 2 groups：bronchial pneumonia and lobar pneumonia. The pathogen detection contents of aspirates of NPA and BALF in children of different ages and pneumonia types were analyzed. Results Detection rate of Mycoplasma pneumoniae （MP） [56.8% （42/74 cases） ] in the BALF of bronehopneumonia group was significantly higher than that [ 18.9% （14/74 cases）] in the lobar pneumonia group（χ^2 = 22. 522 ,P 〈 0.01 ）. Detection rate of MP[ 89.0% （121/136 cases） ] in the BALF of bronchial pneumonia group was significantly higher than that in NPA [ 72.1% （98/ 136 cases） ] ; （χ^2= 12. 397, P 〈 0.01 ） , while detection rates of MP in NPA （72.1% ） and BALF （ 89.0% ） of lobar pneumonia group were significantly higher than those of bacteria [ 7.4% （ 10/136 cases） , 2.9% （ 4/136 cases） ] and virus [ 15.4% （21/136 cases） , 11.0% （ 15/136 eases） ] （χ^2 = 31. 350,156. 371,272. 355, all P 〈 0.01）. MP detection rates of lobar pneumonia group （72. 1% ,89.0% ） were higher than those of bronchial pneumonia group （ 18.9% , 56.8% ）in NPA and BALF （χ^2= 54. 374,28. 628, all P 〈 0.01 ）. Bacterial detection rates of bronehical pneumonia group [ 24.3% （ 18/74 cases）, 18.9% ] in NPA and BALF were higher than those of lobar pneumonia group （7.4%, 2.9% ） （χ^2 = 11. 945,15. 612, all P 〈 0. 01 ）. Virus detection rate of bronchial pneumonia group in NPA [ 33.8% （25/74 cases） ] was higher than that of lobar pneumonia group（ 15.4% ） （χ^2 =9. 426,P 〈0.01 ）. MP detection rates in BALF were higher than those in NPA in all age groups （χ^2 = 8. 125 ,P 〈 0.01 ;χ^2 = 5. 475 ,P 〈 0.05 ;χ^2 = 9. 543, P 〈0.01 ;χ^2=7. 175 ,P 〈0.05）. MP detection rate in BALF of infant group was significantly higher than those of bacteria and virus （χ^2 = 16. 402 ,P 〈0. 01 ）. MP detection rates in NPA and BALF of preschool and school - age children were significantly higher than those of bacteria and viruses （χ^2 = 55. 203,138. 765,63. 256,108.117, all P 〈 0.01 ）. Conclusions The positive rate is high in lobar pneumonia and elder children in NPA. BALF should be consi-dered for detecting pathogens if pneumonia was refractory or etiology was uncertain especially in bronchopneumonia and young patients.