儿童SCAP原学检测和危险因素分析

Pathogen detection and risk factor analysis of severe community-acquired pneumonia in children

目的了解儿童重症社区获得性肺炎(SCAP)的病原谱,并对其致病危险因素进行分析。方法以2008年1月至2013年12月期间来武汉市第八医院儿科就诊的4 050例社区获得性肺炎患儿为研究对象,从中筛选出重症社区获得性肺炎患儿526例,采集526例患儿的痰标本进行细菌检测和病毒检测;对上述研究对象进行病毒RNA提取及基因扩增,应用非条件Logistic回归进行影响因素分析。结果重症社区获得性肺炎以幼儿发病较常见,细菌检出率39.16%,病毒检出率37.64%;年龄、合并基础疾病、呼吸道合胞病毒(RSV)感染、是否合并胸腔积液、血红蛋白浓度、症状持续时间、白细胞计数等是儿童SCAP发病的主要影响因素(OR值分别为0.652、5.660、1.890、1.310、1.580、1.390、1.450,均P<0.05);小于1岁者感染程度最高,占55.7%,到6岁以上感染程度降低到2.5%。结论重症社区获得性肺炎发病呈现明显的季节性和年龄性,细菌是主要病原,合并基础性疾病、RSV感染和革兰氏阴性菌是其发病的主要影响因素。

Objective To master the pathogen spectrum of severe community-acquired pneumonia （SCAP） in children and to analyze the risk factors.Methods A total of 4 050 children with CAP who visiting pediatrics department of Eighth Hospital of Wuhan City from January 2008 to December 2013 were studied.Of these children, 526 with SCAP were chosen as subjects.Sputum samples were collected for bacteria and virus detections.RNA extraction and gene amplification of the virus were performed for these subjects.Unconditional Logistic regression analysis was conducted to analyze influencing factors.Results SCAP was more commonly observed in children.The detection rate was 39.16% for bacteria and 37.64% for virus, respectively.Age, underlying diseases, RSV infection, whether pleural effusion presented or not, hemoglobin concentration, duration of symptoms and white blood cell count were the major influencing factors of SCAP in children （OR value was 0.652, 5.660, 1.890, 1.310, 1.580, 1.390 and 1.450, respectively, all P〈0.05）.Infection rate was highest in patients 〈1 year old, which reached 55.7%.But it decreased to 2.5% in patients 〉6 years old.Conclusion SCAP is obviously related to season and age.Its major pathogens are bacteria.Underlying diseases, RSV infection and gram-negative bacteria are the main influencing factors of the onset of this disease.