细菌感染在患儿急性或长期哮喘发作加剧中的作用

Role of bacterial infection in exacerbation of acute or long-term asthma attacks in children

目的探讨细菌感染与患儿急性或长期哮喘发作加剧的关系,为患儿急性或长期哮喘发作期的治疗提供参考。方法选取西安市中心医院2017年3月至2018年5月收治的250例支气管哮喘急性发作期患儿作为研究对象,对患儿进行血清C反应蛋白(CRP)测定,并进行外周血血常规检验,分析患儿病原菌鉴定结果,根据病情程度不同将患儿纳入轻度组(n=72)、中度组(n=118)及重度组(n=60),比较三组患儿的感染病原特征。结果250例哮喘患儿送检标本中痰培养结果阳性者145例(58.00%),共检出病原菌181株。病原菌中革兰阴性菌比例最高(64.09%),主要是卡他莫拉菌、流感嗜血杆菌。革兰阳性菌比例为34.81%,主要是肺炎链球菌。痰培养阳性组患儿中白细胞(WBC)>10.0×109/L和C-反应蛋白(CRP)≥8 mg/L的例数略多于阴性组,但差异均无统计学意义(P>0.05)。轻度组患儿检出的主要病原菌是卡他莫拉菌,中度组和重度组患儿主要病原菌是肺炎链球菌。轻度组、中度组和重度组患儿的肺炎链球菌检出率分别为18.06%、25.42%、23.33%,差异有统计学意义(P<0.05);轻度组、中度组和重度组患儿的流感嗜血杆菌检出率分别为18.06%、7.63%、18.33%,差异有统计学意义(P<0.05);三组患儿的住院时间比较差异无统计学意义(P>0.05)。结论卡他莫拉菌和肺炎链球菌检出率较高,细菌感染在患儿急性或长期哮喘发作加剧中可能起到了一定作用,尤其是肺炎链球菌及流感嗜血杆菌。WBC和CRP可作为协诊细菌感染的指标,并结合感染中毒症状慎重选择抗生素。

Objective To explore the relationship between bacterial infection and exacerbation of acute or long-term asthma in children, and to provide reference for the treatment of acute or long-term asthma in children.Methods A total of 250 patients of bronchial asthma in acute attack in the Central Hospital of Xi’an City from March2017 to May 2018 were selected as research subjects. The serum C reaction protein(CRP) was measured in the children,and the peripheral blood routine test was carried out to analyze the results of the pathogenic bacteria identification in the children. The children were included in the mild group(n=72), moderate(n=118), and severe group(n=60) according to the degree of the disease. The characteristics of pathogens were compared among the three groups. Results Among250 children with asthma, 145(58.00%) were found with positive results in sputum culture. A total of 181 strains of pathogenic bacteria were detected, mainly Gram-negative bacteria(64.09%, mainly Moraxelle catarrhalis and Haemophilus influenzae), followed by Gram-positive bacteria(34.81%, mainly Streptococcus pneumonia). The number of patients with WBC>10.0×109/L and CRP≥8 mg/L in sputum culture-positive group was slightly larger than that in sputum culture-negative group, but the difference was not statistically significant(P>0.05). The main pathogenic bacteria detected were Moraxelle catarrhalis in the mild group, and Streptococcus pneumoniae in the moderate and severe groups. The detection rates of Streptococcus pneumoniae in mild group, moderate group, and severe group were 18.06%, 25.42%, and23.33%, respectively, with significant difference among the three groups(P<0.05). The detection rates of Haemophilus influenzae in mild group, moderate group and severe group were 18.06%, 7.63%, and 18.33%, respectively, with significant difference among the three groups(P<0.05). There was no significant difference in hospitalization time between the three groups(P>0.05). Conclusion The detection rates of Moraxella catarrhalis and Streptococcus pneumoniae are high.Bacterial infection may play a role in exacerbation of acute or long-term asthma attack in children, especially Streptococcus pneumoniae and Haemophilus influenzae. WBC and CRP can be used as indicators for the diagnosis of bacterial infections, and antibiotics should be carefully selected according to the symptoms of infection and poisoning.