儿童社区获得性肺炎病原体分布特点分析

Analysis of distribution characteristics of pathogens in children with community acquired pneumonia

目的了解北京地区社区获得性肺炎(community acquired pneumonia,CAP)患儿呼吸道病原检测结果及分布特点。方法选取2014年12月至2017年12月(其中2016年无数据)于首都儿科研究所附属儿童医院就诊的533例CAP患儿血液及呼吸道分泌物(痰液、胸水、肺泡灌洗液)并进行检测。检测项目包括肺炎支原体IgM抗体、肺炎支原体抗体滴度;18种呼吸道病毒核酸(Luminex技术);呼吸道分泌物细菌培养;G及GM试验、呼吸道分泌物真菌培养。结果肺炎支原体检测结果显示,女性阳性率(48.1%)高于男性(32.9%),且随年龄增长阳性率逐渐增加,学龄儿组(57.0%)最高。病毒核酸检测结果显示,男性阳性率(59.2%)高于女性(47.4%),且随年龄增长阳性率逐渐降低,婴儿组(83.8%)最高。呼吸道合胞病毒、乙型流感病毒、腺病毒于2014年、2017年秋冬季(3.8%～21.8%)高发,偏肺病毒在2014年冬季(26.7%)高发,而肠道病毒与鼻病毒感染在春夏季更明显(21.4%～32.8%)。结论肺炎支原体及病毒均在儿童CAP致病微生物中占据着重要地位,要警惕以年份为特点的儿童肺炎支原体及病毒感染的流行和暴发。

Objective This Investigation was performed to understand the features and characteristics of the respiratory pathogens in the community acquired pneumonia(CAP) of patients that resident in the Beijing area. Method We collected 533 blood and respiratory secrete samples, including sputum, hydrothorax, and bronchoalveolar lavage ? uid, from the patients that diagnosed as CAP in our hospital from December, 2014 to December, 2017. The samples were performed tests included IgM antibody test and antibody titer of mycoplasma pneumoniae;nucleic acid test for 18 different types of respiratory virus with Luminex technique;bacteria culture of respiratory secrete;G and GM tests, together with fungus culture of respiratory secrete. Result Mycoplasma pneumoniae test showed that the positive rate of women(48.1%) was higher than that of men(32.9%). The morbidity of Mycoplasma pneumoniae pneumonia(MPP)is increased with age, and is highest in the school-age group(57.0%). Viral nucleic acid test showed that the positive rate of males(59.2%) was higher than that of females(47.4%). The morbidity of viral infection was decreased with age, and was highest in infants group(83.8%).The prevalence of MPP and viral pneumonia was signi? cantly correlate to the year in a contrary trend, but not to the season differences.Respiratory syncytial virus, influenza B virus, adenovirus were more common in autumn and winter of 2014 and 2017(3.8%-21.8%),metapneumovirus was more common in winter of 2014(26.7%), while enterovirus and rhinovirus infection were more common in spring and summer(21.4%-32.8%). Conclusion Mycoplasma pneumoniae and virus were dominant in the pathogen of CAP patients in pediatrics.The year differences in epidemic and fulminant characteristics of pediatric mycoplasma pneumoniae and virus infection should be noticed.