婴儿百日咳混合感染的病例对照研究

A case-control study on mixed infection in infants with pertussis

目的探讨婴儿百日咳混合感染发生率是否明显高于非百日咳呼吸道感染婴儿,及其混合感染病原分布状况,供临床诊疗参考。方法采用病例对照研究。纳入2018年8月至2021年1月北京儿童医院、嘉兴市妇幼保健院和芜湖市第一人民医院临床申请百日咳病原学检测(百日咳鲍特菌培养和特异核酸检测)的婴儿鼻咽拭子共118例,根据百日咳病原学检测结果分为百日咳组(65例)和非百日咳组(53例),2组病例中有33对病例按月龄、发病季节、地市进行匹配,标本均应用可检测21种呼吸道感染病原体的FilmArray RP2技术评估其他病原感染状况,比较两组混合感染率差异。组间率的比较采用χ^(2)检验。结果百日咳组婴儿FilmArray RP2多种病原检测阳性率为56.9%(37/65),明显高于非百日咳组的15.1%(8/53),差异有统计学意义(χ^(2)=21.651,P<0.001)。百日咳组混合感染前5位混合感染病原为人鼻病毒/肠道病毒(38.5%,25/65)、副流感病毒(18.5%,12/65)、呼吸道合胞病毒(10.8%,7/65)、冠状病毒(10.8%,7/65)、腺病毒(7.7%,5/65)。百日咳组在春、夏、秋、冬季混合感染检出率分别为46.2%(6/13)、58.3%(14/24)、55.6%(5/9)、63.2%(12/19)。配对病例和非配对病例中两组比较,与上述结果相似。结论临床疑诊婴儿百日咳送检标本中,确诊百日咳者混合感染发生率明显高于非百日咳婴儿。混合感染病原以人鼻病毒/肠道病毒、副流感病毒、呼吸道合胞病毒、冠状病毒、腺病毒等为主。百日咳混合感染四季均常见,以冬季为著。

Objective To examine whether the mixed infection rate in pertussis infants is significantly higher than that in non-pertussis infants with respiratory tract infection,to explore the mixed infection pathogen distribution in pertussis infants,and to provide reference for clinical diagnosis and treatment.Methods A case-control study was conducted on 118 nasopharyngeal swabs collected from infants who applied for clinical pertussis etiological testing(culture and specific nucleic acid detection of Bordetella pertussis)in Beijing Children′s Hospital,Jiaxing Maternity and Child Health Care Hospital and Wuhu No.1 People′s Hospital from August 2018 to January 2021.According to the pertussis etiological testing results,the patients were divided into the pertussis group(65 cases)and non-pertussis group(53 cases).Thirty-three pairs of cases were matched according to age,onset season and city.All nasopharyngeal swabs were tested for infections of other pathogens using FilmArray RP2,which can detect 21 respiratory infection pathogens.The mixed infection rate was compared between groups by Chi-square test.Results According to the FilmArray RP2 test results,56.9%(37/65)cases in pertussis group and 15.1%(8/53)cases in the non-pertussis group were positive for multiple pathogens,and the difference was statistically significant(χ^(2)=21.651,P<0.001).The top 5 mixed infection pathogens in pertussis infants were human rhinovirus/enterovirus(HRV/EV)(38.5%,25/65),parainfluenza virus(PIV)(18.5%,12/65),respiratory syncytial virus(RSV)(10.8%,7/65),coronavirus(Cov)(10.8%,7/65),and adenovirus(ADV)(7.7%,5/65).The mixed infection rates of the pertussis group in spring,summer,autumn and winter were 46.2%(6/13),58.3%(14/24),55.6%(5/9),and 63.2%(12/19),respectively.Comparison of matched and unmatched cases achieved similar results.Conclusions Among clinical suspected pertussis infant specimens,the mixed infection rate in confirmed cases is tremendously higher than that in non-pertussis infants.The main mixed infection pathogens in pertussis infants are HRV/EV,PIV,RSV,Cov,and ADV.Mixed infection in pertussis children commonly occurs in four seasons,with the highest incidence in winter.