住院患儿肺炎合并胸腔积液病原学特点分析

Analysis of Etiological Characteristics of Pneumonia Complicated with Pleural Effusion in Hospitalized Children

目的:探讨住院患儿肺炎合并胸腔积液的病原学特点,为肺炎合并胸腔积液患儿合理诊疗提供病原学参考。方法:收集2010-2018年苏州大学附属儿童医院收治的361例肺炎合并胸腔积液住院患儿的病历资料及痰标本。采用直接免疫荧光法检测7种常见呼吸道病毒,荧光定量聚合酶链式反应(PCR)法检测肺炎支原体(MP)、肺炎衣原体(CP)及博卡病毒(HBoV)、结核杆菌,逆转录-聚合酶链反应(RT-PCR)法检测鼻病毒(HRV)及偏肺病毒(hMPV),并进行细菌培养。入院24 h内及治疗7~10 d采集患儿静脉血,采用酶联免疫吸附测定(ELISA)法检测血清特异性MP抗体IgG、IgM。结果:361例肺炎合并胸腔积液患儿总病原学检出率为82.83%,其中MP检出率67.59%,病毒检出率15.51%,细菌检出率19.39%,混合感染检出率20.50%,结核杆菌检出率2.22%。病毒检出以hBoV、HRV为主,细菌检出以肺炎链球菌(SP)、流感嗜血杆菌(HI)为主,混合感染以细菌+MP、病毒+MP为主。肺炎合并胸腔积液患儿1~3岁组病毒检出率最高,>6岁组患儿病毒检出率最低(P<0.05),MP检出率随着年龄的增长逐渐升高(P<0.05)。1~3岁组、>3~6岁组患儿细菌检出率均高于>6岁组(P<0.05),1~3岁组患儿混合感染率最高(P<0.05)。MP夏季检出率最高,春季检出率最低(P<0.05),病毒夏季检出率相对较低,而细菌秋冬季节检出率相对较高。结论:MP为肺炎合并胸腔积液最重要的病原体,尤其在夏秋季节;其次为SP,随着年龄增长MP检出率增加,混合感染及结核感染也不容忽视。

Objective:To probe into the etiological characteristics of pneumonia complicated with pleural effusion in hospitalized children,so as to provide pathogenic reference for rational diagnosis and treatment of children with pneumonia and pleural effusion.Methods:Medical records and sputum specimens of 361 hospitalized children with pneumonia complicated with pleural effusion admitted into Children’s Hospital of Soochow University from 2010 to 2018 were collected.Seven kinds of common respiratory virus were detected by direct immunofluorescence.Fluorescence quantitative polymerase chain reaction(PCR)was used to detect Mycoplasma pneumoniae(MP),Chlamydia pneumoniae(CP),Boka virus(HBoV)and Mycobacterium tuberculosis.Rhinovirus(HRV)and human metapneumovirus(hMPV)were detected by reverse transcription-polymerase chain reaction(RT-PCR),and the bacteria were cultured.Venous blood was collected within 24 h after admission and after treatment for 7 to 10 d.MP antibody IgG and IgM were detected by enzyme-linked immunosorbent assay(ELISA).Results:The total pathogenic detection rate of 361 children with pneumonia complicated with pleural effusion was 82.83%,of which MP detection rate was 67.59%,virus detection rate was 15.51%,bacteria detection rate was 19.39%,mixed infection rate was 20.50%,and M.tuberculosis detection rate was 2.22%.Viruses were mainly detected by hBoV and HRV,bacteria were mainly detected by Streptococcus pneumoniae(SP)and Haemophilus influenzae(HI),and mixed infections were mainly detected by bacteria+MP and virus+MP.The virus detection rate was the highest in children with pneumonia complicated with pleural effusion from 1 to 3 years,and the lowest in children>6 years(P<0.05),the MP detection rate increased gradually with the increase of age(P<0.05).The bacterial detection rate of children from 1 to 3 years and>3 to 6 years was significantly higher than that of>6 years(P<0.05),and the mixed infection rate of children from 1 to 3 years was the highest(P<0.05).The detection rate of MP was the highest in summer and the lowest in spring(P<0.05).The detection rate of virus was relatively low in summer,while that of bacteria was relatively high in autumn and winter.Conclusion:MP is the most major pathogen of pneumonia complicated with pleural effusion,especially in the summer and autumn,followed by SP.With the age increasing,the MP detection rate is increased.And mixed infection and tuberculosis can not be ignored.