入托对儿童急性上呼吸道感染发病及咽部病原体变化的影响

Effect of nursery care on the incidence of acute upper respiratory tract infection and the change of pharyngeal pathogens in children

目的了解入托对儿童急性上呼吸道感染(AURI)发病及咽部病原体变化的影响,为制定有效的AURI预防措施及治疗对策提供参考。方法选取91名首次于本市某公立幼儿园入托的健康学龄前儿童,入托前体检及首学期入托期间首次发生AURI后行咽拭子多病原体检测,探讨入托后集体生活对咽部病原体变化的影响。结果 91名儿童发病前后咽拭子标本分离细菌种次无明显差别,AURI发病后≥2+细菌总比例高于基线(42.28%vs. 33.77%,P=0.036);发病前支原体阳性1名(1.1%),衣原体及呼吸道病毒7项均未检出。发病后病毒及支原体阳性25名(27.47%),前后差别有统计学意义(χ~2=37.11,P<0.001)。经过分析,51.65%为细菌感染、27.47%为非细菌感染,其中混合感染5.50%,常见病原体在发病时间上存在集中分布趋势。结论健康学龄前儿童咽部存在细菌混合定植,病毒及支原体、衣原体定植极为罕见。幼儿园集体生活可能促进儿童AURI发生及互相传播,加强托幼机构儿童保健及疾病预防工作十分重要。

Objective To understand the influence of nursery care on the incidence of acute upper respiratory tract infection(AURI) and the change of pharyngeal pathogens in children, so as to provide reference for the development of effective AURI prevention measures and treatment strategies. Methods Ninety-one healthy preschoolers enrolled in a public kindergarten for the first time in this city were examined for pharyngeal swab pathogens before the first physical examination and after the first time of AURI in the kindergarten.And the influence of collective life on the change of pharyngeal pathogens was analyzed. Results There was no significant difference on the number of bacterial species isolated from pharynx swabs before and after AURI occurrence in 91 children, and the total proportion of bacteria(≥2+) after getting AURI was higher than the baseline(42.28% vs.33.77%, P=0.036).One case(1.1%) was positive for Mycoplasma, while chlamydia and 7 respiratory viruses were not detected before nursery care.However, 25 cases(27.47%) were positive for viruses and Mycoplasma after AURI, and the difference was statistically significant(χ~2=37.111, P<0.001).Further analysis indicated that 51.65% were bacterial infections, 27.47% were non-bacterial infections, of which 5.50% were mixed infections.There was a tendency of concentrated distribution of common pathogens in the occurrence time of AURI. Conclusions There are mixed colonization of bacteria exists in the pharynx of healthy preschoolers, and the colonization of viruses, mycoplasma and Chlamydia is extremely rare.Collective life in kindergartens may induce the occurrence and transmission of AURI among children.So it is very important to strengthen child health care and disease prevention in kindergartens.