唐山某医院儿童社区获得性肺炎病原学与免疫状况的相关性分析

The correlation between etiology analysis and immune status of children patients with community-acquired pneumonia from a hospital in Tangshan

目的:分析唐山某医院儿童社区获得性肺炎(CAP)病原学特征,并探讨社区获得性肺炎病原学与免疫状况的相关性。方法:选取2014年1月至2015年8月在我院进行治疗的CAP患儿136例为病例组,其中喘息性CAP组81例,非喘息性CAP组55例;选取健康儿童40例为对照组。对CAP患儿进行病原学分析,检测并比较两组C反应蛋白(CRP)、血清降钙素(PCT)、白细胞计数(WBC)、中性粒细胞(NUET)等指标水平及免疫因子CD_4^+、CD_8^+T细胞水平。结果:本组病例以细菌感染为主(40例,29.41%),细菌感染以肺炎链球菌感染为主(16例,40.00%);CAP患儿的CRP、PCT水平均明显高于对照组,其中,细菌感染组CRP、PCT水平最高,其次为肺炎支原体感染组、混合感染组(P<0.05);细菌感染组Ig G、Ig M、Ig E水平最高,其次为肺炎支原体感染组、混合感染组(P<0.05),5组Ig A水平差异无统计学意义(F=1.879,P=0.265);细菌感染组CD+8T细胞水平最高,而CD4^+T细胞、CD_4^+/CD_8^+水平最低,肺炎支原体感染组、混合感染组次之(P<0.05)。结论:体液免疫与细胞免疫功能异常在儿童CAP发病过程中起重要作用,机体的免疫状况直接影响对感染的抵抗能力,细菌感染患儿的体液免疫与细胞免疫功能紊乱最为明显。

Objective： To analyze the correlation between etiology and immune status of children patients with community-acquired pneumonia from a hospital in Tangshan. Methods： 136 CAP children and 40 healthy controls were selected. C- reactive protein（ CRP）,procalcitonin（ PCT）,white blood cell（ WBC）,Neutrophil count（ NUET） and CD4^＋、CD8^＋T cell levels were detected and compared. Results： The patients with bacterial infection accounted for a highest proportion（ 40 cases,29. 41%）; bacterial infection with Streptococcus pneumoniae infection was the most（ 16 cases,40. 00%）; CRP,PCT levels of CAP children were significantly higher than those of the control. CRP,PCT levels of bacterial infection group were the highest,followed by Mycoplasma pneumoniae infection,mixed infection group（ P〈0. 05）; Ig G,Ig M,Ig E levels of bacterial infection were the highest,followed by Mycoplasma pneumoniae infection,mixed infection group（ P〈0. 05）; Ig A levels of the 5 groups was not statistically significantly different（ F = 1. 879,P = 0. 265）; CD8^＋T cell of bacterial infection group was the highest,and CD4^＋T cell,CD4^＋/ CD8^＋ was the lowest（ P〈0. 05）. Conclusion： The humoral and cellular immune dysfunction plays an important role in the pathogenesis of CAP in children. The immune status directly affects the volume resistance to infection. The humoral and cellular immune dysfunction of bacterial infection is most obvious.