肺部感染患儿致病菌分布、危险因素及TLR-4、Ⅳ-C水平的变化分析

Analysis of pathogenic bacteria distribution and risk factors in pediatric pulmonary infection

目的研究儿科肺部感染患儿的致病菌主要分布状况并分析危险因素。方法选取2016年2月至2018年8月于深圳市龙华区中心医院儿科接受腹部外科手术发生肺部感染的患儿100例(感染组)。另取同期未发生感染的患儿100例(非感染组)。分析100例肺部感染患儿致病菌分布状况,比较两组患儿的各项相关因素,并作多因素分析。将感染组患儿按照病情严重程度分为全身炎症反应综合征(SIRS)组67例以及多器官功能障碍综合征(MODS)组33例,比较两组血浆白细胞表面Toll样受体4(TLR-4)以及Ⅳ型胶原蛋白(Ⅳ-C)水平。结果100例肺部感染患儿共检出162株致病菌,其中铜绿假单胞菌41株(25.31%)、肺炎克雷伯菌30株(18.52%)、金黄色葡萄球菌23株(14.20%)、肺炎链球菌19株(11.73%)、大肠埃希菌18株(11.11%)、流感嗜血球菌14株(8.64%)、不动杆菌9株(5.56%)。经单因素及多因素分析发现,侵入性操作、慢性呼吸系统疾病、低蛋白血症、广泛应用抗生素、机械通气时间、住院时间均是儿科肺部感染的独立危险因素(P均<0.05)。MODS组血浆TLR-4(37.24±2.55)%、Ⅳ-C(166.32±32.49)ng/mL水平均高于SIRS组(18.02±1.33)%、(85.72±17.25)ng/mL,差异均有统计学意义(P均<0.05)。结论儿科肺部感染患儿的主要致病菌为铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌等,其中侵入性操作、慢性呼吸系统疾病、低蛋白血症、广泛应用抗生素、机械通气时间、住院时间均与儿科肺部感染的发生存在密切相关。

Objective To study the distribution of pathogenic bacteria in pediatric pulmonary infection and analyze the risk factors.Methods 100 children with pulmonary infection who received treatment in Pediatrics of Longhua District Central Hospital of Shenzhen City from February 2016 to August 2018 were selected as infection group.Another 100 children without infection who received treatment during the same period were selected as the non-infected group.The distribution of pathogenic bacteria in 100 children with pulmonary infection was analyzed,and the related factors were compared between the two groups,and multiple factors were analyzed.In addition,the children in the infection group were divided into 67 cases of systemic inflammatory response syndrome(SIRS)group and 33 cases of multiple organ dysfunction syndrome(MODS)group according to the severity of the disease.Two groups of plasma cells surface toll-like receptor 4(TLR-4)andⅣtype collagen(Ⅳ-C)level were compared.Results The proportion of the 162 pathogenic bacteria strains of 100 children with pulmonary infection were Pseudomonas aeruginosa 25.31%,Klebsiella pneumoniae 18.52%,Staphylococcus aureus 14.20%,Streptococcus pneumoniae 11.73%,Escherichia coli 11.11%,Haemophilus influenzae 8.64%and Acinetobacter 5.56%.Based on single and multi-factor analysis,it could be concluded that invasive operation,chronic respiratory disease,hypoproteinemia,extensive use of antimicrobial agents,mechanical ventilation time and hospital stay were all independent risk factors for pediatric pulmonary infection(all P<0.05).The levels of plasma TLR-4(37.24±2.55)%and IV-C(166.32±32.49)ng/mL in the MODS group were significantly higher than those in the SIRS group[(18.02±1.33)%,(85.72±17.25)ng/mL](all P<0.05).Conclusions The main pathogens of children with pediatric pulmonary infections were Pseudomonas aeruginosa,Klebsiella pneumonia and Staphylococcus aureus.Invasive procedures,chronic respiratory diseases,hypoalbuminemia,widespread use of antibacterial drugs,mechanical ventilation time,and length of hospital stay were all closely related to the occurrence of pediatric pulmonary infections.