先天性心脏病合并社区获得性肺炎患儿呼吸道病毒及特殊病原体相关分析

Correlation analysis of respiratory viruses and special pathogens in children with congenital heart disease complicated with community acquired pneumonia

目的探讨先天性心脏病(CHD)合并社区获得性肺炎患儿与单纯社区获得性肺炎患儿呼吸道病毒和特殊病原体抗体分布特点。方法选取2014年1月~2019年8月于我院儿科住院的721例社区获得性肺炎患儿进行回顾性分析,根据患儿有无合并先天性心脏病分为先天性心脏病组(CHD组)208例和单纯社区获得性肺炎组(LRI组)513例。采用间接免疫荧光法检测血清嗜肺军团菌IgM抗体(LP1A)、肺炎支原体IgM抗体(MPA)、Q热立克次体IgM抗体(QR-FA)、肺炎衣原体IgM抗体(CPnA)、腺病毒IgM抗体(ADVA)、呼吸道合胞病毒IgM抗体(RSVA)、甲型流感病毒IgM抗体(IAVA)、乙型流感病毒IgM抗体(IBVA)、副流感病毒IgM抗体(PIVsA)等9种呼吸道病原体抗体及特殊病原体IgM抗体。比较两组9种呼吸道病原体及特殊病原体检出阳性率、不同年龄阶段、不同季节分布情况。结果CHD组纳入研究的呼吸道病原体抗体九项检测,阳性共136例,LRI组纳入研究的呼吸道病毒及特殊病原体九项,阳性共305例,CHD组病原体IgM总阳性率(65.4%)高于LRI组阳性率(59.4%),但两组比较差异无统计学意义(P>0.05)。CHD组与LRI组均以肺炎支原体(MP)最常见,其次为乙型流感病毒(IBV),其余病毒及呼吸道特殊病原体检出阳性率较低。CHD组和LRI组相比较,在婴幼儿时期,CHD组较易感染MP,但在1~3岁时,则是易感染IBV(均P<0.05);冬春季,CHD组较易感染MP及IBV,而LRI组较易感染LP1及ADV,但两组LP1阳性率均低,无临床指导意义。结论CHD合并社区获得性肺炎患儿特殊病原体抗体谱与单纯社区获得性肺炎患儿相似,以MP最常见;在婴幼儿期及冬春季,CHD合并社区获得性肺炎患儿较单纯社区获得性肺炎患儿易于感染MP;在1~3岁年龄段及冬春季,易于感染IBV。

Objective To analyze the distribution characteristics of respiratory viruses and special pathogens in children with congenital heart disease complicated with community-acquired pneumonia and children with simple community-acquired pneumonia.Methods 721 children with community-acquired pneumonia hospitalized in our hospital from January 2014 to August 2019 were retrospectively analyzed.According to whether the children had congenital heart disease,they were divided into congenital heart disease group(CHD group)with 208 cases and simple community-acquired pneumonia group(LRI group)with 513 cases.Indirect immunofluorescence method was used to detect the serum levels of Legionella pneumophila IgM antibody(LP1A),Mycoplasma pneumoniae IgM antibody(MPA),Rickettsia Q fever IgM antibody(QR FA),Chlamydia pneumoniae IgM antibody(CPNA),adenovirus IgM antibody(ADVA),respiratory syncytial virus IgM antibody(RSVA),influenza A virus IgM antibody(IAVA),influenza B virus IgM antibody(IBVA)and parainfluenza.There were 9 kinds of respiratory tract pathogen antibodies and specific pathogen IgM antibodies.The positive rate of 9 kinds of respiratory pathogens and special pathogens,the distribution of different ages and seasons were compared between the two groups.Results The total positive rate of IgM in CHD group(65.4%)was higher than that in LRI group(59.4%),but there was no significant difference between the two groups(P>0.05).In CHD group and LRI group,Mycoplasma pneumoniae(MP)was the most common,followed by influenza B virus(IBV),and the positive rate of other viruses and respiratory special pathogens was low.Compared with LRI group,CHD group was more likely to be infected with MP in infancy,but it was more likely to be infected with IBV in 1-3 years old(all P<0.05).In winter and spring,CHD group was more likely to be infected with MP and IBV,while LRI group was more likely to be infected with Lp1 and adv,but the positive rate of Lp1 in both groups was low,which had no clinical significance.Conclusion The specific pathogen antibody spectrum of children with CHD complicated with community-acquired pneumonia was similar to that of children with simple community-acquired pneumonia,and MP was the most common.In infancy,winter and spring,children with CHD combined with community-acquired pneumonia are more likely to be infected with MP than children with community-acquired pneumonia alone.It is easy to be infected with IBV in 1-3 years old and winter and spring.