宜昌市住院儿童难治性社区获得性肺炎的病原体及临床特征分析

Analysis of pathogens and clinical characteristics of refractory community-acquired pneumonia children hospitalized in Yichang

目的分析了解宜昌市儿童难治性社区获得性肺炎(RCAP)的病原构成、分布情况及不同病原体肺炎患儿的临床特征,为RCAP的防治提供客观依据,减少不合理用药。方法选取2012年10月至2016年7月RCAP患儿及普通CAP患儿(各252例),收集统计患儿的年龄、性别、住院时间等一般资料和临床资料。应用间接免疫荧光法(IFA)对血清标本进行检测常见病原体,包括肺炎支原体(MP)、肺炎衣原体(CP)、呼吸道合胞病毒(RSV)、腺病毒(ADV)、甲型流感病毒(IFVA)、乙型流感病毒(IFVB)及副流感病毒(PIV)等,血清酶联免疫法检测EB病毒和巨细胞(CMV)抗体及多种检测方法检测其他病原体。结果 252例RCAP组患儿中,191例病原学检测结果阳性,总阳性率75.79%高于CAP组(55.95%),其中病毒感染(24.60%)、细菌感染(15.87%)、真菌感染(0.79%)和混合感染(14.68%)比例均高于CAP组(P<0.05),而非典型病原体感染(19.84%)比例低于CAP组(26.19%)(P<0.05)。RCAP组中EBV、ADV、IFVB占前3位,而在CAP组RSV、PIV、IFVB分别占前3位。RCAP组在伴随发热、发热持续时间、咳嗽持续天数、并发症及平均住院天数方面与CAP组相比均有显著性差异(P<0.05)。RCAP组136例(53.97%)患儿以大片状密度增高影为主,明显高于CAP组(30.56%)(P<0.05);RCAP组病毒感染、非典型病原体及真菌感染以大片状密度增高影为主,细菌感染及以小片状密度增高影为主。结论本市住院RCAP患儿主要以病毒感染为主,其次为非典型病原体、细菌感染,EBV、ADV及IFVB病毒感染是RCAP形成的主要病原体。RCAP以持续高热、咳嗽为主要症状,并可引发多种并发症,病程较长,甚至迁延不愈。影像学检查对不同肺炎病原体的诊断具有一定的倾向性。

Objective To analyze the clinical characteristics and pathogens of children with refractory community-acquired pneumonia,in order to provide an objective basis for RCAP in early clinical empirical treatment to reduce the unreasonable use of antibiotic drugs. Methods RCAP and CAP children（ 252 cases in each group） were chosen from Oct 2012 to Jul 2016. Their age,gender,hospitalization time and other general information and clinical data were collected. Based on indirect immunofluorescence（ IFM） assay,common pathogens such as MP,CP,RSV,ADV,IFVA,IFVB and PIV were detected. EBVCA-Ig G,and CMV-Ig M were detected by ELISA,and other pathogens were detected by different test methods. Results 191 cases had been detected with at least one pathogen,and the positive rate was 75. 79% in the RCAP group,which was higher than 55. 95% in the CAP group. The positive rate of virus（ 24. 60%）,bacteria（ 15. 87%）,fungus（ 0. 79%） and multiple pathogens（ 14. 68%） in the RCAP group were higher than those in the CAP group（ P〈0. 05）,but the positive rate of atypical pathogen（ 9. 84%） in the RCAP group was lower than that in the CAP group（ 26. 19%）（ P〈0. 05）. The top 3 virus were EBV,ADV and IFVB in the RCAP group,but RSV,PIV and IFVB were the top 3 virus in the CAP group. Duration of fever,cough last days,complications and the average hospital stay in the RCAP group had a significant difference with the CAP group（ P〈0. 05）. 136 children（ 53. 97%） in the RCAP group showed large high density patches,which was higher than that in the CAP group（ 30. 56%）（ P〈0. 05）. The imaging of virus,atypical pathogen and fungus mainly showed large high density patches,but bacteria mainly showed small high density patches. Conclusion In the RCAP group,the largest number of pathogen is virus,followed by atypical pathogen and bacteria. The EBV,ADV and IFVB are the major pathogen for RCAP. Prolonged high fever and cough are cardinal symptoms for RCAP,and it usually induces many complications and longer course. Imaging examination has a certain tendency in diagnosis of different pneumonia pathogens.