呼吸道合胞病毒混合细菌感染患儿的免疫炎症状态

Immuno-inflammatory status of children with mixed respiratory syncytial virus and bacterial infection

目的 分析呼吸道合胞病毒(RSV)混合细菌感染患儿的免疫炎症状态。方法 检测863例RSV感染患儿痰或鼻咽分泌物以及肺泡灌洗液的相关病原体以及血清炎症因子水平和免疫功能指标。分析RSV混合细菌感染的危险因素。结果 863例RSV感染患儿中,617例(71.49%)为单纯RSV感染,113例(13.09%)为RSV混合细菌感染。RSV混合细菌感染阳性检出率较高的病原菌分别为肺炎链球菌42例(37.17%)、金黄色葡萄球菌16例(14.16%)、鲍曼不动杆菌16例(14.16%)。与单纯RSV感染组相比,RSV混合细菌感染组血小板计数、血清CRP和IL-6水平以及CD8^(+)T淋巴细胞比例升高(P<0.05),IgG水平、CD4^(+)T淋巴细胞比例和CD4^(+)/CD8^(+)T淋巴细胞比值降低(P<0.05)。多因素logistic逐步回归分析结果显示,CRP高水平(OR=1.052,P<0.01)和IgG低水平(OR=0.649,P<0.01)是RSV混合细菌感染的独立危险因素。结论 RSV混合细菌感染患儿机体处于免疫功能紊乱状态。对于伴CRP水平升高和IgG水平降低的RSV感染患儿,应注意混合细菌感染。

Objective To analyze the immuno-inflammatory status of the children with mixed respiratory syncytial virus(RSV) and bacterial infection.Methods The respiratory pathogens in sputum or nasopharyngeal aspirates and alveolar lavage fluid, and serum levels of inflammatory factors and immune function indicators were detected in 863 children with RSV infection.The risk factors for mixed RSV and bacterial infection were analyzed.Results Of 863 children with RSV infection, 617 cases(71.49%) were with simple RSV infection and 113 cases(13.09%) were with mixed RSV and bacterial infection.The pathogenic bacteria with high positive rate of RSV mixed with bacteria infection were Streptococcus pneumoniae in 42 cases(37.17%),Staphylococcus aureus in 16 cases(14.16%) and Acinetobacter baumannii in 16 cases(14.16%).Compared with simple RSV infection group, the platelet count, serum levels of CRP and IL-6 and proportion of CD8^(+)T lymphocytes were increased(P<0.05),while the IgG level, proportion of CD4^(+)T lymphocytes and CD4^(+)/CD8^(+)T lymphocyte ratio were decreased in RSV mixed bacterial infection group(P<0.05).Multivariate logistic stepwise regression analysis showed that higher CRP level(OR=1.052,P<0.01) and lower IgG level(OR=0.649,P<0.01) were the independent risk factors for RSV mixed with bacterial infection.Conclusion The children with RSV mixed with bacterial infection are in a state of immune dysfunction.More attention should be paid to the mixed bacterial infection in the RSV-positive children with increased CRP level and decreased IgG level.