儿童侵袭性流感嗜血杆菌感染的临床特征及血清学分型

Clinical characteristics and serological typing of invasive Haemophilus influenzae infection in children

目的分析儿童侵袭性流感嗜血杆菌(Hin)感染的临床特征及血清分型特点。方法回顾性分析2015—2021年山西省儿童医院收治的34例侵袭性Hin感染患儿的病例资料。根据临床诊断分为脑膜炎感染组和非脑膜炎感染组。分析患儿的一般资料、症状、体征、实验室血清学指标、Hin血清分型特点及两组间炎症因子水平的差异。结果34例患儿中男22例,女12例,男女比例为1.83∶1,≤36个月患儿占82.35%。脑膜炎感染组患儿降钙素原(PCT)为[23.71(4.10,77.80)]ng/mL、C反应蛋白(CRP)为[200.00(164.55,200.00)]mg/L,均高于非脑膜炎组[分别为1.08(0.49,6.00)ng/mL、69.46(48.09,125.63)mg/L],差异均具有统计学意义(均P<0.05)。血小板计数(PLT)非脑膜炎组[(312.56±186.81)×10^(9)/L]高于脑膜炎组[(183.28±165.67)×10^(9)/L],差异有统计学意义(P<0.05)。白细胞计数(WBC)和中性粒细胞百分比(NEUT)两组间比较,差异无统计学意义(均P>0.05)。分离的Hin菌株中,b型流感嗜血杆菌(Hib)27株,e型2株,f型2株,3株不可分型,未发现a、c、d血清型菌株。脑膜炎感染组与非脑膜炎感染组患儿可分型Hin菌株分布比较,差异无统计学意义(χ^(2)=0.25,P>0.05)。可分型Hin菌株在男、女患儿中的构成比(67.74%VS 32.26%)比较,差异无统计学意义(χ^(2)=1.42,P>0.05)。结论侵袭性Hin感染病例以3岁以内儿童居多,分离株以b型占优势,感染患儿CRP、PCT明显升高,PLT明显低于非感染患儿,对临床诊断有一定应用价值,可结合临床及其他检验项目为侵袭性感染疾病的早期分类诊断及抗感染治疗提供有效支持。

Objective To analyze the clinical and serological typing characteristics of invasive Haemophilus influenzae(Hin)infection in children.Methods Clinical data of 34 children with invasive Hin infection admitted to Children’s Hospital of Shanxi from 2015 to 2021 were analyzed retrospectively.According to clinical diagnosis,they were divided into meningitis infection group and non-meningitis infection group.General data,symptoms,signs,laboratory serological indicators,and Hin serum typing characteristics of children,as well as differences in inflammatory factor level between the two groups were analyzed.Results Among the 34 patients,22 were males and 12 were females,with a male to female ratio of 1.83∶1.Children aged≤36 months accounted for 82.35%.The levels of procalcitonin(PCT)(23.71[4.10,77.80])ng/mL and C-reactive protein(CRP)(200.00[164.55,200.00])mg/L in children in the meningitis infection group were higher than those in the non-meningitis group(1.08[0.49,6.00]ng/mL,69.46[48.09,125.63]mg/L,respectively),with statistically significant differences(both P<0.05).The platelet(PLT)count in the non-meningitis group([312.56±186.81]×10^(9)/L)was higher than that in the meningitis group([183.28±165.67]×10^(9)/L),with statistically significant difference(P<0.05).There was no statistically significant difference in white blood cell(WBC)count and neutrophil(NEUT)percentage between two groups(both P>0.05).Among the isolated Hin strains,27,2,and 2 strains were type b(Hib),e and f,respectively;3 strains were not typed;serotype a,c and d strains were not found.There was no statistically significant difference in the distribution of typeable Hin strains between the two groups(χ^(2)=0.25,P>0.05).There was no statistically significant difference in the constituent rate of typeable Hin strains between male and female children(67.74%vs 32.26%,χ^(2)=1.42,P>0.05).Conclusion The majority of invasive Hin infection cases are children under 3 years old,and the predominant strain is type b.CRP and PCT levels of infected children increased significantly,while PLT is significantly lower than that of non-infected children,which has certain clinical diagnostic value and can provide effective support for early classified diagnosis and anti-infection treatment of invasive infectious diseases combined with other clinical testing items.