社区获得性肺炎患儿EB病毒及肺炎支原体感染情况分析

Analysis of EB infection and Mycoplasma pneumoniae infection in children with community acquired pneumonia

目的分析社区获得性肺炎(CAP)患儿Epstein-Barr病毒(EBV)及肺炎支原体(MP)感染的临床特点。方法选择2015年6月至2016年6月在齐齐哈尔医学院附属第三医院住院治疗的CAP患儿280例,采血,分离血清,采用酶联免疫吸附法(ELISA)检测EBV抗体,采用被动颗粒凝集法检测MP抗体,采用实时荧光定量PCR(qPCR)检测EBV-DNA、MP-DNA。结果 ELISA和被动颗粒凝集试验检测280例CAP患儿单一EBV、MP感染率及EBV+MP混合感染率分别为7.9%(22/280)、31.1%(87/280)和18.9%(53/280),以单一MP感染占多数(P<0.05);不同性别患儿单一EBV、MP感染率及EBV+MP混合感染率差异无统计学意义(P>0.05);按年龄统计单一EBV感染率及EBV+MP混合感染率以3月~1岁组较高(P<0.05),单一MP感染率>5岁~12岁组较高(P<0.05)。随病程的延长,患儿血清EBV-DNA阳性率逐渐降低,MP-DNA阳性率先升高后降低,并于入院后1周达最高(48.7%)。结论 CAP患儿以单一MP感染多见,EBV感染常与MP感染同时存在,且不同年龄患儿EBV、MP感染率不同,动态监测血清EBV-DNA、MP-DNA有助于儿童CAP的早期诊断及疾病进展评估。

Objective To investigate the clinical characteristics of Epstein-Barr virus（EBV）infection and Mycoplasma pneumoniae infection in children with community-acquired pneumonia（CAP）. Methods Subjects were 280 children with CAP who were hospitalized in the Third Affiliated Hospital of Qiqihar Medical School from June 2015 to June 2016.Blood samples were collected from children with CAP and serum was separated.Anti-EBV antibodies were detected with an enzyme-linked immunosorbent assay（ELISA）,anti-M.pneumoniae antibodies were detected using passive particle agglutination,and EBV DNA and M.pneumoniae DNA were detected with real-time quantitative PCR（qPCR）. Results In 280 children with CAP,a single infection with EBV was detected at a rate of 7.9%（22/280）,a single infection with M.pneumoniae was detected at a rate of 31.1%（87/280）,and a mixed infection with EBV＋M.pneumoniae was detected at a rate of 18.9%（53/280）.Infections were mostly a single M.pneumoniae infection（P〈0.05）.The rate at which a single infection with EBV,a single infection with M.pneumoniae,and a mixed infection with EBV＋M.pneumoniae were detected did not differ significantly between children of different genders（P〉0.05）.The rate of detection of a single infection with EBV and a mixed infection with EBV＋M.pneumoniae was higher in children 3 months-1 year of age（P〈0.05）,and the rate of detection of a single infection with M.pneumoniae was higher in children 〉5 years of age and 〈12 years of age（P〈0.05）.Over the course of disease,serum from children with CAP gradually tested less positive for EBV DNA.Serum tested positive for M.pneumoniae DNA at a high rate initially and then at a low rate;positivity for M.pneumoniae DNA peaked 1 week after admission（48.7%）. Conclusion A single M.pneumoniaeinfection is more common in children with CAP,but EBV appears mostly in the form of a mixed infection with M.pneumoniae.The rate of detection of EBV and M.pneumoniae differed in children of different ages.Dynamic monitoring of levels of EBV and M.pneumoniae DNA in serum is helpful for early diagnosis and evaluation of disease progression in children with CAP.