发热儿童急性上呼吸道感染与病毒和细菌的关系

Relationship between Acute Upper Respiratory Tract Infection of Febrile Children and Viruses and Bacteria

目的 了解发热儿童急性上呼吸道感染与病毒和细菌的关系,指导临床治疗。方法 回顾性分析研究2022年9—10月广西壮族自治区妇幼保健院厢竹院区诊治的1338例发热急性上呼吸道感染患儿。根据就诊时诊断及全血WBC和CRP的结果,将两项均正常纳入病毒感染组,两项均升高纳入细菌感染组,只有一项升高的不纳入分组,比较两组间的WBC、中性粒细胞比例、CRP及SAA水平。结果 病毒感染组945例,细菌感染组165例,不纳入分组228例。细菌感染组白细胞、中性粒细胞比率、CRP均高于病毒感染组,组间差异有统计学意义(P<0.001)。各组不同热程上细菌和病毒感染无显著统计学差异(P>0.05)。SAA水平检测结果显示,不同热程上,细菌感染组SAA均较病毒感染组增高,组间差异有统计学意义(P<0.05)。结论 伴有发热的急性上呼吸道感染患儿应注意病毒感染的可能性,CRP常在细菌感染者中增高,而SAA可在细菌和病毒感染者中增高,但增高明显多见于细菌感染,CRP及SAA结合可有助于病原菌的判断。

Objective To understand the relationship between acute upper respiratory tract infection and viruses and bacteria in febrile children,and to guide clinical treatment.Methods A retrospective analysis was conducted on 1338 children with fever and acute upper respiratory tract infection treated in Xiangzhu Branch of Guangxi Zhuang Autonomous Region Maternal and Child Health Hospital from September to October 2022.Based on the diagnosis and results of whole blood WBC and CRP at the time of diagnosis,both items were included in the viral infection group if they were normal,and both items were included in the bacterial infection group if they were elevated.Only one item that was elevated was not included in the group.The WBC,neutrophil ratio,CRP,and SAA levels between the two groups were compared.Results There were 945 cases in the viral infection group,165 cases in the bacterial infection group,and 228 cases not included in the grouping.The white blood cell,neutrophil ratio,and CRP in the bacterial infection group were higher than those in the viral infection group,and the differences between the groups were statistically significant(P<0.001).There was no significant statistical difference(P>0.05)in bacterial and viral infections among different heat stages in each group.Detection of SAA levels in bacterial and viral infection groups:The results showed that SAA levels in bacterial infection groups were higher than those in viral infection groups at different heat stages,and the difference between groups was statistically significant(P<0.05).Conclusion Children with acute upper respiratory tract infections accompanied by fever should pay attention to the possibility of viral infection.CRP is often elevated in bacterial infections,while SAA can be elevated in both bacterial and viral infections,but the increase is more common in bacterial infections.The combination of CRP and SAA can help determine the pathogen.