冬春季儿童急性下呼吸道感染病原菌分布及炎症指标联合应用的鉴别诊断作用

Distribution of pathogenic bacteria in children with acute lower respiratory tract infection and combined differential diagnosis of inflammatory markers

目的了解儿童急性下呼吸道感染的细菌、非典型呼吸道病原体分布、流行趋势,为临床预防及合理诊治提供参考。方法采用多重RT-PCR与毛细管电泳联合技术检测呼吸道病原体,同时回顾性统计分析痰培养阳性、病毒感染患者临床病例资料及实验室检测结果,并随机选取同期健康体验儿童作为对照组。结果1478份痰液培养标本检测出致病菌416株(28.1%);随机选择600例呼吸道标本进行13项病原学检测,总阳性率为16.2%(97/600),其中鼻病毒、呼吸道合胞病毒、腺病毒、肺炎支原体、甲型流感病毒、副流感病毒构成比分别为47.4%、12.4%、7.2%、6.2%、13.4%、10.3%;病毒阳性组SAA、PCT、CRP指标ROC曲线下面积分别为0.790、0.117、0.271;其中SAA/CRP曲线下面积最大,为0.976。结论儿童急性下呼吸道感染以细菌为主;非典型呼吸道病原体感染引起的急性下呼吸道感染患儿中以HRV易感性最高。

Objective To understand the distribution and epidemic trend of bacteria and atypical respiratory pathogens in children with acute lower respiratory tract infection.Methods Multiple RT-PCR and capillary electrophoresis were used to detect respiratory pathogens,and the clinical data and laboratory test results of patients with positive sputum culture.Results A total of 416 strains(28.1%)were detected in 1478 sputum culture samples.A total of 600 respiratory specimens were randomly selected for 13 etiological tests,with a positive rate of 16.2%(97/600).The constituent ratios of rhinovirus,respiratory syncytial virus,adenovirus,Mycoplasma pneumoniae,influenza A virus and parainfluenza virus were 47.4%,12.4%,7.2%,6.2%,13.4%and 10.3%,respectively.The area under ROC curve of SAA,PCT and CRP were 0.790,0.117 and 0.271,respectively.The area under the ROC curve of SAA/CRP was 0.976.Conclusion Bacteria are the main cause of acute lower respiratory tract infection in children.Among the children with acute lower respiratory tract infection caused by atypical respiratory pathogens,HRV was the most susceptible.