儿童重症肺炎病原学及PCT和IL-8及CRP水平变化的临床意义

Etiological characteristics of children with severe pneumonia and clinical significance of PCT,IL-8 and CRP

目的了解重症肺炎(SP)患儿病原菌分布及耐药性,并分析患儿降钙素原清除率(PCTc)、白细胞介素-8(IL-8)、C-反应蛋白(CRP)水平变化及临床意义。方法选取2022年1月-2023年6月绍兴市中心医院收治的142例SP患儿(SP组)及90例普通肺炎患儿(普通肺炎组)为研究对象,采集SP患儿呼吸道痰液,进行细菌培养及药敏分析;检测所有患儿入院时IL-8、CRP水平及治疗24h的PCTc;SP组患儿根据治疗10d后临床效果,分为好转组和恶化组,比较两组临床资料及PCTc、IL-8、CRP水平,采用多因素Logistic回归分析法探究患儿预后影响因素。结果142例SP患儿痰培养共分离病原菌163株,其中革兰阴性菌以肺炎克雷伯菌、铜绿假单胞菌为主;肺炎克雷伯菌对氨苄西林、头孢唑林耐药率>80%;铜绿假单胞菌对氨苄西林、头孢唑林绝对耐药,对磺胺甲噁唑/甲氧苄啶、头孢西丁耐药率>80%;SP组PCTc低于普通肺炎组,IL-8、CRP高于普通肺炎组(P<0.05);好转组小儿危重病例评分(PCIS)较恶化组高(P<0.05),致病菌种类2种、机械通气、伴并发症占比较恶化组低(P<0.05);好转组PCTc高于恶化组,IL-8、CRP低于恶化组(P<0.05);PCIS评分、PCTc、IL-8、CRP均是SP患儿预后的影响因素(P<0.05)。结论SP患儿以革兰阴性菌感染为主,常见病原菌对青霉素类、头孢菌素类抗菌药物耐药性普遍较高,临床应根据病原菌种类及耐药性合理使用抗生素;SP患儿PCTc水平较低,IL-8、CRP升高,且与患儿不良预后有关。

OBJECTIVE To understand the distribution and drug resistance of pathogenic bacteria in children with severe pneumonia(SP),and to analyze the changes and clinical significance of procalcitonin clearance rate(PCTc),interleukin-8(IL-8)and C-reactive protein(CRP).METHODS A total of 142 children with SP(as the SP group)and 90 children with common pneumonia(as the common pneumonia group)admitted to Shaoxing Central Hospital from Jan 2022 to Jun 2023 were recruited.Respiratory sputum of children with SP was collected for bacterial culture and drug sensitivity analysis.The levels of IL-8 and CRP at admission and PCTc after 24 hours of treatment were detected among all children.According to the clinical effect after 10 days of treatment,the children in the SP group were subdivided into the improvement group and deterioration group.The clinical data and levels of PCTc,IL-8 and CRP between the two groups were compared,and the influencing factors for progno-sis in children were explored by multivariate logistic regression analysis.RESULTS 163 strains of pathogenic bacte-ria were isolated from sputum culture samples of 142 SP children,including gram-negative bacteria,mainly Kleb-siella pneumoniae and Pseudomonas aeruginosa.The drug-resistant rates of K.pneumoniae to ampicillin and ce-fazolin were more than 80%.P.aeruginosa was absolutely drug-resistant to ampicillin and cefazolin,and the drug-resistant rates to compound sulfamethoxazole and cefoxitin were more than 80%.PCTc in the SP group was lower than that in the common pneumonia group,while IL-8 and CRP were higher than those in the common pneumonia group(P<0.05).The pediatric critical illness score(PCIS)in the improvement group was higher than that in the deteriorated group(P<0.05),and proportions of two types of pathogenic bacteria,mechanical ventila-tion and complications in the improvement group were lower than those in the deterioration group(P<0.05);PCTc in the improvement group was higher while IL-8 and CRP were lower compared to the deterioration group(P<0.05).PCIS score,PCTc,IL-8 and CRP were the influencing factors of prognosis in SP children(P<0.05).CONCLUSION Children with SP are mainly infected by gram-negative bacteria.Common pathogenic bacteria are generally highly drug-resistant to penicillins and cephalosporins.It is necessary to rationally use antibiotics accord-ing to the types and drug resistance of pathogenic bacteria.The level of PCTc in children with SP reduces while the levels of IL-8 and CRP increase,which are related to the poor prognosis of children.