婴儿早期沙眼衣原体肺炎临床特征分析

Analysis of clinical characteristics of Chlamydia trachomatis pneumonia at early infancy

目的了解婴儿早期社区获得性肺炎(CAP)患儿沙眼衣原体(CT)的病原学分布及临床特点,以期为临床经验性抗感染治疗提供依据。方法回顾性分析2017年1月至2018年3月深圳市儿童医院收治的968例CAP婴儿患儿[(28~119)d]中146例沙眼衣原体肺炎(CTP)患儿的临床资料,并对其进行统计学分析。结果 CT DNA阳性146例,检出率为15.1%(146/968)。CTP患儿临床表现以咳嗽(146/146,100%)、咳痰(118/146,80.8%)、肺部湿啰音(86/146,58.9%)及咳嗽后面红(60/146,41.1%)多见,部分有鼻塞(57/146,39.0%)、咳嗽后呕吐(39/146,26.7%)及气促(28/146,19.2%)。平均住院日为(5.27±3.75)d,重症患儿比例低(9/146,6.2%),经治疗后均好转出院。自然分娩比例较高(90.4%)。病原学方面,CT高于流感嗜血杆菌(125/968,12.9%)、呼吸道合胞病毒(RSV)(121/968,12.5%)等。CT混合感染多见(85/146,58.2%),混合感染出现喘息及三凹征比例高于单纯CT感染(单一感染),但并不延长患儿住院时间。入院后使用抗生素137例(93.8%)。平均使用(4.85±4.04)d,其中1例使用37 d,使用1周及以上22例(18.0%)。137例中,使用红霉素或阿奇霉素109例(79.6%)。结论 CT是婴儿早期CAP最常见病原体,混合感染可能加重病情。对婴儿早期CAP可选大环内酯类抗生素抗感染治疗。

Objective To understand the pathogenic distribution and clinical characteristics of Chlamydia trachomatis (CT) in children with community-acquired pneumonia(CAP)at early infancy,so as to provide evidence for clinical empirical anti-infection treatment.Methods The clinical data of 146 children with Chlamydia trachomatis pneumonia(CTP)aged 28 days to 119 days admitted to Shenzhen Children’s Hospital from January 2017 to March 2018 were retrospectively and statistically analyzed.Results In this study,146 patients were positive for CT DNA,and the detection rate was 15.1%(146/968).The common clinical manifestations of the children with CTP were cough(146/146,100%),expectoration(118/146,80.8%),lung moist rale(86/146,58.9%),and flushing after cough(60/146,41.1%).Some patients had rhinobyon(57/146,39.0%),vomiting after cough(39/146,26.7%)and polypnea(28/146,19.2%).The average length of hospital stay was(5.27±3.75)days,and the proportion of seriously ill children was low(9/146,6.2%).All the children got better and were discharged after treatment.In terms of CAP etiology,CT was higher than Haemophilus influenzae(125/968,12.9%)and respiratory syncytial virus(RSV)(121/968,12.5%).Mixed CT infection was more common(85/146,58.2%),and the proportion of wheezing and three-depression signs of mixed infection was higher than that of pure CT infection(single infection),but the hospital stay of the children was not prolonged.137 infants(93.8%)received antibiotics treatment after admission.The average treatment time was(4.85±4.04)d,more than 1 week was about 22 patients(18.0%),including one for 37 days.109 infants(79.6%)received erythromycin or azithromycin of the 137 cases.Conclusion CT is the most common pathogen in CAP at early infancy,and mixed infection may aggravate the disease.Treatment with azithromycin or erythromycin is effective and has a good prognosis.For infants with CAP at early infancy,macrolides are the first choice for anti-infection treatment.