合并其他病原感染的百日咳患儿临床特征与炎症指标特点

Clinical manifestations and inflammatory indicators of children with pertussis complicated with other pathogens

目的探索百日咳患儿混合感染病例的临床表现和炎症指标特点。方法收集2017年1月1日至2018年12月31期间所有在西安市儿童医院感染三科住院治疗且病原学确诊的百日咳患儿共686例,据病原构成分为仅百日咳杆菌(Bp)感染(仅Bp组,207例)、合并肺炎且未查见合并其他病原(Bp+肺炎组,225例)和Bp明确混合其他病原(Bp+其他病原组,254例),分析比较各组的临床表现和炎症特点。结果 254例Bp+其他病原组中Bp+细菌感染者110例(16.04%),Bp+病毒感染者120例(17.49%),18例(2.62%)同时混合了细菌和病毒感染,6例(0.88%)合并了真菌感染;仅Bp组、Bp+肺炎组、BP+其他病原组三组入院时日龄、咳嗽病程、伴气喘、伴发热、超敏C反应蛋白(hsCRP)升高、降钙素原(PCT)升高总体差异有统计学意义(H/χ^2值分别为6.421、8.793、15.627、78.446、12.827、13.610,均P<0.05),经两两比较发现,Bp+肺炎组咳嗽病程短于其他两组,仅Bp组伴气喘、伴发热、HsCRP升高、PCT升高比例低于其他两组;Bp+细菌组伴发热比例低于Bp+病毒组,PCT升高比例高于Bp+病毒组,差别有统计学意义(Z/χ^2值分别为16.494、5.647,均P<0.05);Logistic回归分析结果显示PCT升高是混合细菌感染与否的独立危险因素,OR值及95%CI为20.252(2.467~166.280)。结论百日咳患儿伴发热、伴气喘、CRP升高或PCT升高应考虑存在混合感染,PCT升高越明显,混合细菌感染风险越高。

Objective To explore the clinical manifestations and inflammatory indicators of coinfection in children with pertussis.Methods A total of 686 children with pertussis admitted to the third infectious diseases department of Xi’an Children’s Hospital and confirmed by etiology from January 1,2017 to December 31,2018 were collected.According to the pathogen composition,all of them were divided into only Bordetella pertussis(Bp) infection(Bp only group,207 cases),complicated with pneumonia but no other pathogens detected(Bp+ pneumonia group,225 cases) and Bp clearly complicated with other pathogens(Bp+ other pathogens group,254 cases).Clinical manifestations and inflammatory characteristics of each group were analyzed and compared.Results Among the 254 cases of Bp+ other pathogens,110(16.04%) were infected with Bp+ bacteria,120(17.49%) were infected with Bp+ virus,18(2.62%) were infected with both bacteria and virus,and 6(0.88%) were infected with fungus.The differences of the age at admission,cough duration,wheeze,fever,hypersensitive C-reactive protein(hsCRP) and procalcitonin(PCT) increase among Bp only group,Bp+ pneumonia group and Bp+ other pathogen group were statistically significant(H/χ2 values were 6.421,8.793,15.627,78.446,12.827 and 13.610,respectively,all P<0.05).The cough duration of Bp+ pneumonia group was shorter than that of the other two groups,and the proportions of wheeze,fever,elevated PCT and elevated hsCRP of Bp only group were lower than that of the other two groups.The proportions of Bp+ bacteria with fever was lower than that of Bp+ virus group,and the proportion of increased PCT was higher than that of Bp+ virus group,the differences were statistically significant(H/χ2 values were 16.494 and 5.647,respectively,all P<0.05).Logistic regression analysis showed that increased PCT was an independent risk factor for mixed bacterial infection,the OR value and 95%CI was 20.252(2.467-166.280).Conclusion Children with pertussis with fever,wheeze,elevated CRP or elevated PCT should consider coinfection.The more obvious the increase in PCT,the higher the risk of mixed bacterial infection.