163例儿童甲型流感共感染病例临床特征分析

Clinical characteristics analysis of 163 cases of co infection with influenza A in children

目的 分析儿童甲型流感合并其他不同病原体感染患儿的临床特征。方法 选取163例甲流合并其他病原体感染患儿为本次研究对象,同时随机选取同期单纯甲流患儿90例为对照组。于患儿就诊住院当日采集患儿标本。患儿咽后壁和鼻腔拭子标本经培养后,采用直接免疫荧光法检测甲流病毒、乙型流感病毒、副流感病毒、呼吸道合胞病毒、腺病毒,采用逆转录-聚合酶链反应方法(RT-PCR)检测博卡病毒、偏肺病毒、鼻病毒、冠状病毒、肺炎支原体。鼻咽拭子分别接种于不同培养基中,培养后采用全自动微生物鉴定系统鉴定病原菌类型。所有患儿于次日早晨空腹状态下抽取外周血,使用全自动血液分析仪检查白细胞计数、C反应蛋白(CRP)水平。结果 163例甲流合并其他病原体感染患儿中,45.40%合并细菌感染,34.97%合并其他病毒感染,19.63%合并肺炎支原体感染。合并其他细菌感染患儿中,主要为肺炎链球菌、流感嗜血杆菌、卡他莫拉菌合并感染。合并其他病毒感染患儿中,主要为呼吸道合胞病毒、乙型流感病毒合并感染。甲流合并细菌感染患儿年龄主要分布于6个月~1岁,与单纯甲流患儿对比,出现发热、咳嗽、鼻塞流涕、腹泻、白细胞计数升高、CRP升高患儿占比及发病年龄分布差异有统计学意义(P<0.05),并发肺炎患儿占比差异无统计学意义(P>0.05)。甲流合并其他病毒感染患儿年龄主要分布于3~6岁,与单纯甲流患儿对比,出现发热、鼻塞流涕、腹泻、白细胞计数升高患儿占比及发病年龄分布情况差异有统计学意义(P<0.05),发生咳嗽、肺炎、CRP升高患儿占比差异无统计学意义(P>0.05)。甲流合并肺炎支原体感染患儿年龄主要分布于>6岁,与单纯甲流患儿对比,出现发热、咳嗽、肺炎、白细胞计数升高、CRP升高患儿占比及发病年龄分布情况差异有统计学意义(P<0.05),出现鼻塞流涕、腹泻患儿占比差异无统计学意义(P>0.05)。结论 儿童甲流合并其他病原体感染患儿中,主要为合并肺炎链球菌与呼吸道合胞病毒感染。单纯甲流感染患儿与合并不同病原体感染患儿的发病年龄分布不同,合并不同临床症状的发病率及实验室检查结果有差异。

Objective The clinical characteristics of influenza A infection in children with other different pathogens were analyzed.Methods The clinical data of 163 children with influenza A and other pathogen infections who were treated in the respiratory department of Children's Hospital in Hebei were selected as the subjects of this study,while 90 children with influenza A alone during the same period were randomly selected as the control group.On the day of hospitalization,relevant professional medical personnel collected samples of the child.After culturing the swab samples from the posterior pharyngeal wall and nasal cavity of the child,influenza A virus,influenza B virus,parainfluenza virus,respiratory syncytial virus,and adenovirus were detected by direct immunofluorescence assay.Boca virus,metapneumovirus,rhinovirus,coronavirus,and Mycoplasma pneumoniae were detected by Reverse transcription polymerase chain reaction(RT-PCR).Nasopharyngeal swabs were inoculated in different media,and after cultivation,the pathogen species were identified by a fully automated microbial identification system.All children were taken peripheral blood on an empty stomach in the morning of the next day,and their white blood cell count and C-reactive cell level were checked by a fully automated blood analyzer.Results Among 163 children with influenza A and other pathogens,45.40%were associated with bacterial infection,34.97%with other viral infections,and 19.63%with M.pneumoniae infection.Among children with other bacterial infections,the main ones were infections caused by Streptococcus pneumoniae,Haemophilus influenzae,and Moraxella catarrhalis.Among children infected with other viruses,respiratory syncytial virus and influenza B virus were mainly co infected.The age of children with influenza A and bacterial infection was mainly distributed between 6 months and 1 year old.Compared with clinical data of children with influenza A alone,it was found that there was a statistically significant difference in the proportion of children with fever,cough,nasal congestion and runny nose,diarrhea,elevated white blood cell count,and elevated C-reactive protein,as well as in the age distribution of the onset(P<0.05),while there was no statistically significant difference in the proportion of children with pneumonia(P>0.05).The age of children with influenza A and other virus infections was mainly distributed between the ages of 3 and 6 years.Compared with clinical data of children with influenza A alone,it was found that there was a statistically significant difference in the proportion of children with fever,nasal congestion and runny nose,diarrhea,elevated white blood cell count,and age distribution of the onset(P<0.05),while there was no statistically significant difference in the proportion of children with cough,pneumonia,and elevated C-reactive cells(P>0.05).The age of children with influenza A and M.pneumoniae infection was mainly distributed over the age of 6 years.Compared with clinical data of children with influenza A alone,it was found that there was a statistically significant difference in the proportion of children with fever,cough,pneumonia,elevated white blood cell count,and elevated C-reactive protein,as well as in the distribution of age at onset(P<0.05).There was no statistically significant difference in the proportion of children with nasal congestion,runny nose,and diarrhea(P>0.05).Conclusion Among children infected with influenza A and other pathogens,S.pneumoniae and respiratory syncytial virus infections were the main causes.The age distribution of children with influenza A infection was different from that of children with different pathogens,and the incidence rate of children with different clinical symptoms and laboratory test results were different.