509例儿童社区获得性肺炎病原体及临床特征分析

Analysis of pathogens and clinical characteristics of 509 children with community acquired pneumonia

目的了解儿童社区获得性肺炎(community-acquired pneumonia,CAP)病原分布状况及其临床特征。方法回顾性分析509例CAP住院患儿的病例资料,分析各种病原的检测结果及不同病原CAP的临床特点。结果 509例CAP患儿中,299例病原学检测阳性,阳性率58.74%。其中,肺炎支原体128例(25.15%)、乙型流感病毒90例(17.68%)、副流感病毒49例(9.63%)、呼吸道合包病毒18例(3.54%)、腺病毒18例(3.54%)、甲型流感病毒2例(0.39%)。352例患儿细菌学检查中,43例细菌培养结果阳性,其中流感嗜血杆菌22例(6.25%),肺炎链球菌17例(4.83%),金黄色葡萄球菌2例(0.57%),肺炎克雷伯杆菌1例(0.28%),大肠埃希菌1例(0.28%);2种以上病原混合感染50例(9.82%)。肺炎支原体、病毒在≤3岁和>3岁组的检出率有差异(P<0.05)。肺炎支原体肺炎患儿在患病年龄、发热、喘息症状、中性粒比值、C反应蛋白(CRP)上与乙型流感病毒肺炎有差异(P<0.05)。>5岁与≤5岁的肺炎支原体肺炎患儿的喘息比例、入院体温、白细胞数、中性粒比及CRP值有差异(P<0.05)。结论该地区儿童CAP常见的病原有肺炎支原体、乙型流感病毒、流感嗜血杆菌等。病毒是3岁以下儿童CAP的主要病原,以乙型流感病毒常见;肺炎支原体感染多见于3岁以上患儿,5岁以上患儿炎症反应更重。不同病原CAP临床特点不同,肺炎支原体肺炎患儿的患病年龄、发热症状比例、中性粒比值、CRP值高于乙型流感毒性肺炎患儿;喘息症状比例较后者低。

Objective To understand the pathogens distribution and clinical characteristics of community -acquired pneumonia （CAP） in children.Methods The data of 509 cases of hospitalized children with CAP were retrospectively analysed.Detection re-sults of various pathogens and clinical characteristics of CAP with different pathogens were also analysed.Results Overall,299 cases had been detected with at least one pathogen,and the positive rate was 58.74%.Among them,128 cases were MP positive （25.15%）, 90 cases influenza B virus positive （17.68%）,49 cases parainfluenza virus positive （9.63%）,18 cases respiratory syncytial virus positive （3.54%）,18 cases adenovirus positive （3.54%）,2 cases influenza A virus positive （0.39%）,22 cases haemophilus influ-enzae positive （6.25%）,17 cases streptococcus pneumoniae positive （4.83%）,2 cases staphylococcus aureus positive （0.57%）,1 case Klebsiella pneumoniae positive （0.28%）,and 1 case Escherichiacoli positive （0.28%）.Two or more pathogens infections were present in 50 out of 509 cases （9.63%）.The detection rates of mycoplasma pneumoniae or virus have significant differences between the less than 3 years old group and the more than 3 years old group （P 〈0.05）,The age,ratio of fever and breathing,neutrophil per-centage and C reactive protein of the cases with mycoplasma pneumoniae pneumonia have differences as compared to the cases infected by influenza B virus.The ratio of breathing,admission body temperature,white blood cell count,neutrophil percentage and C reactive protein of the cases with mycoplasma pneumoniae pneumonia have differences between the less than 5 years old group and the more than 5 years old group.Conclusions Mycoplasma pneumoniae pneumonia,influenza B virus and haemophilus influenzae were common pathogens of CAP in children in this region.Virus was the main pathogen of CAP children under 3 years old,especially the influenza B virus.Mycoplasma pneumoniae was more prevalent in more than 3 years old children.Children more than 5 years old with mycoplasma pneumoniae pneumonia have a heavier inflammatory reaction.Community -acquired pneumonia in children has different clinical char-acteristics with different pathogens.The ratio of fever, neutrophil percentage and C reactive protein of the cases with mycoplasma pneu-moniae pneumonia were higher than CAP children infected by influenza B virus,while the ratio of breathing was lower than CAP infec-ted by influenza B virus.