急性呼吸道感染患儿肺炎支原体和肺炎衣原体病原学特征分析

Analysis of the etiological characteristics of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with an acute respiratory infection and an examination of their clinical significance

目的了解对急性呼吸道感染住院患儿肺炎支原体和肺炎衣原体病原学特征,为临床诊疗提供指导。方法采集2013-2015年间在我院住院的急性呼吸道感染儿童患者的血清样本,采用ELISA法检测血清MP-IgM和血清CP-IgM,对肺炎支原体和肺炎衣原体感染特征进行分析。结果 1376例急性呼吸道感染住院患儿血清样本中共分离233株病原体,阳性率16.93%,其中肺炎支原体214株(91.85%),肺炎衣原体19株(8.15%)。2013年病原体阳性率12.26%(39/318),肺炎支原体和肺炎衣原体分别为30株和9株;2014年病原体阳性率16.05%(74/461),肺炎支原体和肺炎衣原体分别为68株和6株;2015年的病原体阳性率20.10%(120/597),肺炎支原体和肺炎衣原体分别为116株和4株。春季分离病原体58株,阳性率23.11%(58/251),均为肺炎支原体;夏季分离病原体86株,阳性率13.98%(86/508),均为肺炎支原体;秋季分离病原体38株,阳性率10.98%(38/346);冬季分离病原体51株,阳性率18.82%(51/271)。男性患儿分离病原体156株,阳性率18.44%(156/846);女性患儿分离病原体77株,阳性率14.53%(77/530)。<1岁患儿病原体阳性率19.21%(44/229),1~3岁患儿病原体阳性率16.23%(93/573),3~6岁患儿病原体阳性率10.09%(35/347),6~12岁患儿病原体阳性率26.87%(61/227)。421例急性上呼吸道感染患者分离病原体124株,阳性率29.45%,543例急性支气管炎患者分离病原体92株,阳性率为16.94%,344例急性支气管肺炎患者分离病原体17株,阳性率为4.94%,均为肺炎支原体。52例喉气管支气管炎患者和16例哮喘合并感染患者均未检出病原体。结论肺炎支原体是急性呼吸道感染患儿的主要病原体,感染情况呈逐年升高趋势。男性6~12岁患儿,尤其是急性上呼吸道感染疾病检出率较高,临床治疗时应给予格外重视。

Objective To determine the etiological characteristics of Mycoplasma pneumoniae and Chlamydia pneurnon iae in children with an acute respiratory infection in this Hospital in order to guide clinical diagnosis and treatment. Methods Serum samples from pediatric inpatients with an acute respiratory infection at this Hospital were collected from 2013-2015. IgM antibodies to M. pneumoniae and C. pneumoniae in serum were detected with ELISA to analyze the characteristics of M. pneumoniae and C. pneumoniae infection. Results Two hundred and thirty-three strains of pathogens were isolated from 1 376 serum samples from pediatric inpatients with an acute respiratory infection at this Hospital. Samples tested positive at a rate of 16. 93%. Isolated pathogens included 214 strains of M. pneumoniae （91.85%） and 19 strains of C. pneumoniae （8. 15%）. In 2013, samples tested positive for pathogens at a rate of 12. 26% （39/318）. Pathogens included 30 strains of M. pneumoniae and 9 strains of C. pneumoniae. In 2014, samples tested positive for pathogens at a rate of 16.05% （74/461）. Pathogens included 68 strains of M. pneumoniae and 6 strains of C. pneumoniae. In 2015, samples tested positive for pathogens at a rate of 20.10%（120/597）. Pathogens included 116 strains of M. pneumoniae and 4 strains of C. pneumoniae. Fifty-eight strains of pathogens were isolated from patients in the spring. Samples tested positive for pathogens at a rate of 23. 11%（58/251）, and the isolated pathogen was M. pneumoniae. Eighty six strains of pathogens were isolated from patients in the summer. Patients tested positive for pathogens at a rate of 13.98% （86/508）, and the isolated pathogen was M. pneumoniae. Thirty-eight strains of pathogens were isolated from patients in the autumn, and patients tested positive for pathogens at arateof 10.98% （38/346）. Fifty one strains of pathogens were isolated from patients in the winter, and patients tested positive for pathogens at a rate of 18.82% （51/ 271）. One hundred and fifty-six strains of pathogens were isolated from male pediatric patients, and patients tested posi- tive for pathogens at a rate of 18.44% （156/846）. Seventy-seven strains of pathogens were isolated from female pediatric patients, and patients tested positive for pathogens at a rate of 14.53 % （77/530）. Pediatric patients younger than the age of 1 tested positive for pathogens at a rate of 19.21% （44/229）, patients ages 1-3 tested positive for pathogens at a rate of 16.23% （93/573）, patients ages 3-6 tested positive for pathogens at a rate of 10.09% （35/347）, and patients ages 6 -12 tested positive for pathogens at a rate of 26.87% （61/227）. In 421 pediatric patients with an acute upper respiratory infection, 124 strains were isolated at a rate of 29.45%. In 543 pediatric patients with acute bronchitis, 92 strains were isolated at a rate of 16.94%. In 344 pediatric patients with acute bronehopneumonia, 17 strains were isolated at a rate of 4.94%. The pathogen isolated from all of those patients was M. pneumoniae. Pathogens were not detected in the 52 pediatric patients with laryngotracheobronehitis or the 16 pediatric patients with asthma. Conclusion M. pneumoniae was the main pathogen infecting children with an acute respiratory infection and the prevalence of infection tended to increase each year. Pathogens were detected at a higher rate in male pediatric patients ages 6--12, and especially those with an a- cute upper respiratory infection. Particular emphasis should be placed on the clinical treatment of those patients.