儿童大叶性肺炎肺泡灌洗液病原学及临床研究

doi:10.3969/j.issn.1000-3606.2020.08.012

临床儿科杂志 ›› 2020, Vol. 38 ›› Issue (8): 607-.doi: 10.3969/j.issn.1000-3606.2020.08.012

儿童大叶性肺炎肺泡灌洗液病原学及临床研究

张丽 1,　章伟 1,　袁博 1,　吴冰霞 2,　谷强 1

1.石河子大学医学院第一附属医院儿科； 2.石河子大学医学院（新疆石河子　832008）

出版日期:2020-08-15 发布日期:2020-08-11
通讯作者: 谷强　电子信箱：guqiang106@sina.com
基金资助:
新疆石河子市社会发展科技攻关与成果转化项目（No. 2018YL02）

Etiology and clinical analysis of bronchoalveolar lavage fluid in children with lobar pneumonia

　ZHANG Li1, ZHANG Wei1, YUAN Bo1, WU Bingxia2, GU Qiang1

1. Department of Pediatrics,The First Hospital Affiliated of Medical College, Shihezi University; 2. Medical College of Shihezi University, Shihezi 832008, Xinjiang, China

Online:2020-08-15 Published:2020-08-11

摘要/Abstract

摘要： 目的　分析儿童大叶性肺炎主要致病原及其临床特点。方法　回顾分析2015年3月至2019年3月住院治疗并采集肺泡灌洗液（BALF）的149例大叶性肺炎患儿的临床资料，分析以荧光定量PCR（FQ-PCR）法检测的BALF中的病原特点，以酶联免疫吸附法（ELISA）检测的血清MP特异性抗体（MP-IgM）水平。比较不同年龄段、MP肺炎与非MP 肺炎、混合感染与单一感染患儿的临床肺部感染评分（CPIS）的差异。结果　149例患儿中，病原体阳性129例，男71例、女58例，1~3岁18例、~6岁40例、~14岁71例。肺炎支原体（MP）阳性107例，肺炎链球菌（SP）18例，腺病毒（ADV）12 例，流感嗜血杆菌（HI） 6例，肺炎克雷伯杆菌（KP） 3例，呼吸道合胞病毒（RSV） 3例，肺炎衣原体（CP） 2例；混合感染23 例，以合并MP、SP居多。1~3岁患儿细菌及病毒感染10例，占同年龄组阳性病例的55.6%；＞ 3岁患儿MP感染99例，占MP阳性病例的92.5%。在107例MP阳性患儿中，BALF以FQ-PCR法检测MP阳性率高于血清MP-IgM，差异有统计学意义（P<0.05）。与非MP肺炎组相比，MP肺炎组患儿胸腔积液、肝功能异常、神经系统受累比例较高，差异有统计学意义（P<0.05）。混合感染组CPIS≥6的患儿比例高于单一感染组，差异有统计学意义（P<0.05）。结论　儿童大叶性肺炎MP检出率最高，其次为SP、ADV，不同年龄段感染的病原体不同，MP是多数混合感染的主要病原体，混合感染更易出现重症或难治病例。

关键词: 大叶性肺炎；　肺泡灌洗液；　病原；　儿童

Abstract: Objective　To analyze the main pathogen types and clinical characteristics of lobar pneumonia in children. Methods　Clinical data of 149 hospitalized children of lobar pneumonia who performed bronchoalveolar lavage fluid (BALF) collecting in March 2015 to March 2019 were collected. Fluorescence quantitative PCR (FQ - PCR) is used to detect pathogens in BALF, and enzyme-linked immunosorbent (assay) was used to detect serum Mycoplasma pneumoniae (MP) antibody specificity (MP - IgM). Clinical pulmonary infection score (CPIS) difference between the two kinds of detection methods, different ages group, the MP pneumonia and non-MP pneumonia, mixed infection and single infection were compared. Results There were 129 cases with positive pathogen, among which 71 were male (55.0%), 58 were female (45.0%), 18 were 1-3 years old (14.0%), 40 were ~6 years old (31.0%), and 71 were ~14 years old (55.0%). There are 107 cases of MP, 18 cases of Streptococcus pneumoniae (SP), 12 cases of adenovirus (ADV), 6 cases of Haemophilus influenzae (HI), 3 cases of Klebsiella pneumoniae (KP), 3 cases of respiratory syncytial virus (RSV) and 2 cases of Chlamydia pneumoniae (CP).There were 23 cases of mixed infection, most of which were MP and SP. There were 10 cases of bacterial and viral infection in the 1-3 year old group, accounting for 55.6% of the positive cases in the same age group. There were 99 cases of MP infection above 3 years old, accounting for 92.5% of the MPpositive cases. In 107 cases of MP infection, the positive rate of MP in BALF detected by FQ-PCR was higher than that in the serum of MP-IgM, with significant difference (P< 0.05). Compared with non-MP pneumonia, MP pneumonia was more prone to pleural effusion, abnormal liver function and nervous system involvement (P< 0.05). The difference between mixed infection and single infection in CPIS ≥ 6 was significant (P< 0.05). Conclusions　The detection rate of MP in children with lobar pneumonia is the highest, followed by SP and ADV. The pathogens of infection are different in different age groups. Mixed infections are more likely to be severe or difficult to be treated.

Key words: Child;　lobar pneumonia;　Bronchoalveolar lavage fluid;　Pathogen

张丽，章伟，袁博，等. 儿童大叶性肺炎肺泡灌洗液病原学及临床研究[J]. 临床儿科杂志, 2020, 38(8): 607-.

ZHANG Li, ZHANG Wei, YUAN Bo, et al. Etiology and clinical analysis of bronchoalveolar lavage fluid in children with lobar pneumonia[J]. Journal of Clinical Pediatrics, 2020, 38(8): 607-.

儿童大叶性肺炎肺泡灌洗液病原学及临床研究

Etiology and clinical analysis of bronchoalveolar lavage fluid in children with lobar pneumonia

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