不同病原体引起的儿童化脓性扁桃体炎的临床特点

Clinical features of acute suppurative tonsillitis caused by different pathogens in children

目的探究不同病原体引起的儿童化脓性扁桃体炎的临床特点。方法选择2014年住院确诊且有明确病原体的化脓性扁桃体炎患儿97例,比较不同病原体引起的化脓性扁桃体炎的流行病学特点、临床症状与体征、实验室检查结果等。结果 A族β溶血性链球菌(GABHS)、EB病毒、腺病毒和肺炎支原体(MP)引起的化脓性扁桃体炎患儿发病年龄分别为(6.29±2.17)、(3.41±1.81)、(3.35±2.50)、(3.88±2.95)岁,差异有统计学意义(P<0.05),其中GABHS感染患儿年龄最大。GABHS感染患儿发病年龄多在5岁以下,冬春季为发病高峰季节。有咽部出血点表现的多为GABHS和腺病毒感染,EB病毒感染患儿易出现肝、脾和颈部淋巴结肿大,腺病毒感染患儿易出现结膜炎。不同病原体引起的急性化脓性扁桃体炎患儿血清中性粒细胞(NC)、C—反应蛋白(CRP)、血清降钙素原(PCT)水平比较,差异均有统计学意义(均P<0.05);与GABHS感染患儿相比,EB病毒、MP感染患儿CRP水平均较低(均P<0.05),EB病毒、腺病毒和MP感染息儿PCT水平均较低(均P<0.05)。结论在化脓性扁桃体炎患儿中,除GABHS感染外,腺病毒、EB病毒和支原体感染也占相当一部分。对于年龄<5岁,冬末春初发病,有明显咽痛、咽后壁出血样表现,CRP明显升高,PCT>0.5 ng/ml的患儿,应考虑GABHS感染的可能,并及早、足疗程使用抗生素。

Objective To review the clinical characteristics of acute suppurative tonsillitis in children caused by different pathogens. Methods Ninety seven children with suppurative tonsillitis admitted from January 2014 to December 2014 were enrolled in the study. The epidemiology, clinical manifestations, laboratory findings were compared in patients with different etiologies. Result The mean age was 6.29 ±2.17, 3.41 ±1.81, 3.35 ± 2.50 and 3.88 ±2.95 years in patients with group A 15-hemolytic streptococcal （GABHS）, EB-virus, adenoviral and mycoplasmal （MP） tonsillitis, respectively （P〈0.05）. Throat bleeding was more common in patients with GABHS and adenoviral tonsillitis. The signs of hepatosplenomegaly and cervical lymphadenopathy were more often in EB-virus infection and conjunctivitis was more often in adenoviral infection. GABHS infection had higher neutrophil count and CRP, PCT levels than other pathogen infection（P〈0.05）. Conclusions Adenovirus, EB-virus and mycoplasma may also the etiology of acute suppurative tonsillitis, in addition to group A β-hemolytic streptococcus. Acute suppurative tonsillitis in children aged 〈5 years, with manifestations of obvious sore throat, posterior pharyngeal wall bleeding and high PCT levels are likely caused GABHS, and early and full course of antibiotics should be administrated.