链球菌感染756例患儿临床分析

Clinical analysis of 756 children with streptococcal infection

目的提高对链球菌感染及其相关疾病的认识。方法回顾性分析756例链球菌感染患儿的临床特点,尤其是除急性肾小球肾炎及风湿热以外的各系统疾病情况。结果 756例患儿中,发现急性肾小球肾炎60例(7.9%),风湿热6例(0.8%),Ig A肾病6例(0.8%),过敏性紫癜145例(19.2%),特发性血小板减少性紫癜12例(1.6%),肾病综合征4例(0.5%),川崎病2例(0.3%),系统性红斑狼疮5例(0.7%),硬皮病1例(0.1%),肺含铁血黄素沉积症1例(0.1%),心肌炎6例(0.8%),心律失常13例(1.7%),关节炎20例(2.6%),癫痫症2例(0.3%),脑血管病2例(0.3%),急性脊髓炎2例(0.3%),情绪障碍4例(0.5%),急性小脑共济失调1例(0.1%),神经系统脱髓鞘疾病2例(0.3%),面神经炎1例(0.1%),中毒性脑病61例(8.1%),皮肤病7例(0.9%),骨髓炎1例(0.1%),化脓性脑膜炎37例(4.9%),上呼吸道感染100例(13.2%),下呼吸道感染255例(33.7%)。各疾病抗O比较差异有统计学意义(χ2=44.472,P<0.001),其中肾脏疾病最高,关节炎次之。抗O与C反应蛋白(CRP)、血沉(ESR)呈正相关(r=0.083、0.116,P<0.05),抗O与C3呈负相关(r=-0.259,P<0.05)。结论链球菌感染发病年龄以学龄期及青春期小儿为主,与多种疾病关系密切,需积极抗链球菌治疗才能达到较好的疗效。

Objective To improve understanding of streptococcal infection and its related diseases. Methods A retrospective analysis was made on clinical characteristics, especially condition of organ and system diseases with the exception of acute glomerulonephritis and rheumatic fever, in 756 children with streptococcal infection.Results Among 756 children patients, there were 60 cases with acute glomerulonephritis （7.9%）, 6 cases with rheumatic fever （0.8%）, 6 cases with IgA nephropathy （0.8%）, 145 cases with anaphylactoid purpura （19.2%）, 12 cases with idiopathic thrombocytopenic purpura （1.6%）, 4 cases with nephrotic syndrome （0.5%）, 2 cases with Kawasaki disease （0.3%）, 5 cases with systemic lupus erythematosus （0.7%）, 1 case with scleroderma （0.1%）, 1 case with pulmonary hemosiderosis （0.1%）, 6 cases with myocarditis （0.8%）, 13 cases with arrhythmia （1.7%）, 20 cases with arthritis （2.6%）, 2 cases with epilepsy （0.3%）, 2 cases with cerebrovascular disease （0.3%）, 2 cases with acute myelitis （0.3%）, 4 cases with emotional disorder （0.5%）, 1 case with acute cerebellar ataxia （0.1%）, 2 cases with neurologic demyelinating diseases （0.3%）, 1 case with facial neuritis （0.1%）, 61 cases with toxic encephalopathy （8.1%）, 7 cases with dermatosis （0.9%）, 1 case with osteomyelitis （0.1%）, 37 cases with suppurative meningitis （4.9%）, 100 cases with upper respiratory infection （13.2%）, and 255 cases with lower respiratory infection （33.7%）. The difference of anti-O in each diseases had statistical significance （χ2=44.472, P〈0.001）, and nephropathy had the highest level, followed by arthritis. Anti-O was positively correlated with C-reactive protein （CRP） and erythrocyte sedimentation rate （ESR） （r=0.083, 0.116,P〈0.05）, and it had negative correlation with C3 （r=-0.259,P〈0.05）.Conclusion Main onset age of streptococcal infection includes school-age and adolescence. This disease is closely related with multiple diseases, and active antistreptococcic treatment is essential for good curative effect.