小儿重症肺炎不同病原抗原及抗体IgM抗体检测特点及流行趋势分析

Detection characteristics and epidemiological trend analysis of different pathogenic antigens and IgM antibodies in children with severe pneumonia

目的探析小儿重症肺炎不同病原抗原及抗体IgM抗体检测特点及流行趋势。方法收集本院2017年1月至2019年12月收治的重症肺炎患儿308例,以免疫荧光法进行肺炎支原体(MP)、肺炎衣原体(CP)、呼吸道合胞病毒(RSV)、腺病毒(ADV)、副流感病毒1型(PIV1)、副流感病毒2型(PIV2)、副流感病毒3型(PIV3)、甲型流感病毒(FA)、乙型流感病毒(FB)、柯萨奇病毒B型(COXB)等多种病原抗原及IgM抗体检测。按照厦门地区气候特点,采用平均气温分类法划分春(公历3~4月),夏(公历5~9月),秋(公历10~11月),冬(公历12~2月),观察不同季节MP、ADV、RSV感染分布特点,调查重症肺炎患儿并发症情况。结果①308例重症肺炎患儿中病原IgM抗体阳性率58.77%(181/308),其中MP感染占比最高,ADV与RSV感染次之,其他包括PIV3、FA、COXB、FB、PIV1、等。单项感染率为41.56%(128/308),双重感染率为13.96%(43/308),多重感染率3.25%(10/308)。②MP感染中3~7岁(学龄前期)感染率最高,明显高于<1岁(婴儿期)与1~3岁(幼儿期),差异有统计学意义(P<0.05),RSV感染中婴儿期与幼儿期明显高于学龄前期,差异有统计学意义(P<0.05),ADV感染中学龄前期、幼儿期明显高于婴儿期,差异有统计学意义(P<0.05)。③男、女患儿MP、ADV感染率比较无统计学意义(P>0.05),男性患儿RSV感染率明显高于女性,差异有统计学意义(P<0.05)。④MP感染夏季最高,ADV感染春、夏季节较高,RSV感染夏季最高。⑤MP感染患儿呼吸衰竭、心肌损害并发症率较高,ADV、RSV感染患儿各类并发症亦频发,且多重感染患儿呼吸衰竭、胸腔积液、心肌损害、肝功能异常等并发症明显高于单一病原体,差异有统计学意义(P<0.05)。结论本院重症肺炎患儿病原体主要以MP、ADV、RSV感染为主,且双重感染风险高;夏季为MP、ADV、RSV感染高危季节;MP、ADV、RSV感染与重症肺炎患儿年龄有关,其中学龄前期MP感染风险最高,而RSV易发于婴儿期,ADV则幼儿期与学龄前期均有较高感染风险。

Objective To explore the detection characteristics and epidemic trend of IgM antibody anti⁃different pathogens in children with severe pneumonia.Methods A total of 308 children with severe pneumonia admitted to Xiamen Children's Hospital from January 2017 to December 2019 were collected.Mycoplasma pneumoniae(MP),Chlamydia pneumoniae(CP),respiratory syncytial virus(RSV),and Virus(ADV),parainfluenza virus type 1(PIV1),parainfluenza virus type 2(PIV2),parainfluenza virus type 3(PIV3),influenza A virus(FA),influenza B virus(FB),Kosa Detection of multiple pathogenic antigens such as parvovirus B(COXB),antigens and IgM antibodies were detected by immunofluorescence.According to the climatic characteristics of Xiamen,the average temperature classification method is used to divide spring(March to April),summer(May to September),autumn(10 to November),and winter(12 to February),seasonal distribution characteristics of MP,ADV and RSV infections were observed.The children with severe pneumonia and their complications were investigated.Results①The positive rate of pathogenic IgM antibodies in 308 children with severe pneumonia was 58.77%(181/308),amongwhich MP infection accounted for the highest proportion,followed by ADV and RSV infection,and others included PIV3,FA,COXB,FB,PIV1.The single infection rate was 41.56%(128/308),the double infection rate was 13.96%(43/308),and the multiple infection rate was 3.25%(10/308).②Among MP infections,the infection rate is the highest between 3 and 7 years old(preschool age),which is significantly higher than<1 year(infancy)and 1 to 3 years(infancy),the difference is statistically significant(P<0.05),infants with RSV infection Period and early childhood are significantly higher than preschool age,the difference is statistically significant(P<0.05).ADV infection in middle school and early childhood is significantly higher than infancy,the difference is statistically significant(P<0.05).③The infection rates of MP and ADV in male and female children were not statistically significant(P>0.05).The RSV infection rates in male children were significantly higher than that in females,and the difference was statistically significant(P<0.05).④MP infection is the highest in summer,ADV infection is higher in spring and summer,and RSV infection is the highest in summer.⑤Children with MP infection have higher rates of respiratory failure and myocardial damage complications.Various complications of children with ADV and RSV infection are also frequent.Children with multiple infections have complications such as respiratory failure,pleural effusion,myocardial damage,and abnormal liver function,significantly higher than that of a single pathogen(P<0.05).Conclusion The pathogens detected in children with severe pneumonia in our hospital are mainly MP,ADV and RSV infections,and the risk of double infection is high.Summer is the high⁃risk season for MP,ADV and RSV infection.MP,ADV,RSV infection is related to the age of children with severe pneumonia.Among them,the risk of MP infection is the highest in preschool age,while RSV is easy to occur in infancy,while ADV has a higher risk of infection in early childhood and preschool age.