中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2011年
6期
508-510
,共3页
社区获得性肺炎%病原学分析%降钙素原%儿童
社區穫得性肺炎%病原學分析%降鈣素原%兒童
사구획득성폐염%병원학분석%강개소원%인동
Community acquired pneumonia%Pathogenic analysis%Procaicitonin%Children
目的 分析嘉兴地区儿童社区获得性肺炎的病原学情况,为临床治疗提供参考.方法 对2008年1月至2010年12月收住本院的800例肺炎患儿做痰细菌培养及呼吸道合胞病毒、腺病毒、流感病毒、副流感病毒的抗原测定,并抽取血样检测肺炎支原体、腺病毒、副流感病毒IgM抗体.对病原学阳性的202例患儿再根据不同病原分为3组:细菌感染组109例,病毒感染组54例,肺炎支原体感染组39例.检测3组患儿入院时血白细胞总数、C反应蛋白及降钙素原(procalcitonin,PCT)水平.结果800例肺炎患儿病原学检测阳性率为25.25％(202/800),其中肺炎链球菌46例(22.77％,46/202)、流感嗜血杆菌32例(15.84％,32/202)、金黄色葡萄球菌5例(2.48％,5/202)、肺炎克雷白杆菌8例(3.96％,8/202)、大肠埃希菌12例(5.94％,12/202)、肺炎支原体39例(19.31％,39/202)、呼吸道合胞病毒48例( 23.76％,48/202)、腺病毒1例(0.50％,1/202)、流感病毒3例(1.49％,3/202)、副流感病毒2例(0.99％,2/202),肺炎链球菌和呼吸道合胞病毒混合感染3例(1.49％,3/202),肺炎链球菌和支原体混合感染3例(1.49％,3/202).1岁以下为呼吸道合胞病毒感染高发年龄；肺炎链球菌各个年龄组均可感染,主要发生在1～3岁；流感嗜血杆菌感染主要发生在3岁以下；6岁以上的年长儿以支原体感染为主.3组患儿的PCT分别为(7.78±6.14) ng/ml、(0.39±0.56) ng/ml、(0.20±0.34) ng/ml,3组间比较差异有统计学意义(P＜0.05).结论 嘉兴地区小婴儿社区获得性肺炎的病原以呼吸道合胞病毒为主,婴幼儿以肺炎链球菌、流感嗜血杆菌为主,年长儿以支原体感染为主,通过年龄、临床表现并结合PCT检测可初步经验性推测可能感染的病原,从而指导临床用药.
目的 分析嘉興地區兒童社區穫得性肺炎的病原學情況,為臨床治療提供參攷.方法 對2008年1月至2010年12月收住本院的800例肺炎患兒做痰細菌培養及呼吸道閤胞病毒、腺病毒、流感病毒、副流感病毒的抗原測定,併抽取血樣檢測肺炎支原體、腺病毒、副流感病毒IgM抗體.對病原學暘性的202例患兒再根據不同病原分為3組:細菌感染組109例,病毒感染組54例,肺炎支原體感染組39例.檢測3組患兒入院時血白細胞總數、C反應蛋白及降鈣素原(procalcitonin,PCT)水平.結果800例肺炎患兒病原學檢測暘性率為25.25％(202/800),其中肺炎鏈毬菌46例(22.77％,46/202)、流感嗜血桿菌32例(15.84％,32/202)、金黃色葡萄毬菌5例(2.48％,5/202)、肺炎剋雷白桿菌8例(3.96％,8/202)、大腸埃希菌12例(5.94％,12/202)、肺炎支原體39例(19.31％,39/202)、呼吸道閤胞病毒48例( 23.76％,48/202)、腺病毒1例(0.50％,1/202)、流感病毒3例(1.49％,3/202)、副流感病毒2例(0.99％,2/202),肺炎鏈毬菌和呼吸道閤胞病毒混閤感染3例(1.49％,3/202),肺炎鏈毬菌和支原體混閤感染3例(1.49％,3/202).1歲以下為呼吸道閤胞病毒感染高髮年齡；肺炎鏈毬菌各箇年齡組均可感染,主要髮生在1～3歲；流感嗜血桿菌感染主要髮生在3歲以下；6歲以上的年長兒以支原體感染為主.3組患兒的PCT分彆為(7.78±6.14) ng/ml、(0.39±0.56) ng/ml、(0.20±0.34) ng/ml,3組間比較差異有統計學意義(P＜0.05).結論 嘉興地區小嬰兒社區穫得性肺炎的病原以呼吸道閤胞病毒為主,嬰幼兒以肺炎鏈毬菌、流感嗜血桿菌為主,年長兒以支原體感染為主,通過年齡、臨床錶現併結閤PCT檢測可初步經驗性推測可能感染的病原,從而指導臨床用藥.
목적 분석가흥지구인동사구획득성폐염적병원학정황,위림상치료제공삼고.방법 대2008년1월지2010년12월수주본원적800례폐염환인주담세균배양급호흡도합포병독、선병독、류감병독、부류감병독적항원측정,병추취혈양검측폐염지원체、선병독、부류감병독IgM항체.대병원학양성적202례환인재근거불동병원분위3조:세균감염조109례,병독감염조54례,폐염지원체감염조39례.검측3조환인입원시혈백세포총수、C반응단백급강개소원(procalcitonin,PCT)수평.결과800례폐염환인병원학검측양성솔위25.25％(202/800),기중폐염련구균46례(22.77％,46/202)、류감기혈간균32례(15.84％,32/202)、금황색포도구균5례(2.48％,5/202)、폐염극뢰백간균8례(3.96％,8/202)、대장애희균12례(5.94％,12/202)、폐염지원체39례(19.31％,39/202)、호흡도합포병독48례( 23.76％,48/202)、선병독1례(0.50％,1/202)、류감병독3례(1.49％,3/202)、부류감병독2례(0.99％,2/202),폐염련구균화호흡도합포병독혼합감염3례(1.49％,3/202),폐염련구균화지원체혼합감염3례(1.49％,3/202).1세이하위호흡도합포병독감염고발년령；폐염련구균각개년령조균가감염,주요발생재1～3세；류감기혈간균감염주요발생재3세이하；6세이상적년장인이지원체감염위주.3조환인적PCT분별위(7.78±6.14) ng/ml、(0.39±0.56) ng/ml、(0.20±0.34) ng/ml,3조간비교차이유통계학의의(P＜0.05).결론 가흥지구소영인사구획득성폐염적병원이호흡도합포병독위주,영유인이폐염련구균、류감기혈간균위주,년장인이지원체감염위주,통과년령、림상표현병결합PCT검측가초보경험성추측가능감염적병원,종이지도림상용약.
Objective To study the etiology of comumunity acquired pneumonia (CAP) in children of Jiaxing city and provide the basis for the clinical diagnosis and treatment.Methods An etiological study was performed on 800 young children with CAP in Jinxing First Hospital from Jan 2008 to Dec 2010.Sputum samples were collected for isolating bacteria and checking the antigen of respiratory syncytial virus ( RSV),adenovirus ( ADV),influenza virus (IV) and parainfluenza virus ( PIV ).IgM antibodies of mycoplasma pneumoniae (MP),ADV,W and PIV paired serum samples were detected.The 202 cases with positive etiology were divided into three groups:bacteria group ( 109 cases),virus group (54 cases) and MP group (39 cases).The leukocyte,C-reactive protein (CRP) and procalcitonin (PCT) were detected.Results The etiology of CAP was identified in 202 (25.25％) children of all the 800 cases,the distribution of causal agents was as follows:Streptococcus pneumoniae in 46 cases (22.77％,46/202 ),Haemophilus influenzae in 32 cases (15.84％,32/202),Staphylococcus in 5 cases (2.48％,5/202),Klebsiella pneumoniae in 8 cases (3.96％,8/202),Escherichia coli in 12 cases (5.94％,12/202),MP in 39 cases ( 19.31％,39/202),RSV in 48 cases (23.76％,48/202),ADV in 1 case (0.50％,1/202),IV in 3 cases ( 1.49％,3/202),and PIV in 2 cases ( 0.99％,2/202 ),Streptococcus pneumoniae and RSV mixed infection in 3 cases ( 1.49％,.3/202),Streptococcus pneumoniae and MP mixed infection in 3 cases ( 1.49％,3/202).RSV infection occured mainly in infants less than 1-year-old,Streptococcus pneumoniae oceured in all ages but was mostly in 1 ～ 3years,Haemophilus influenzae infection occured mainly in infants less than 3-year-old,MP infection occured mainly in infants more than six years.The PCT levels of the three groups were (7.78 ±6.14) ng/ml,(0.39 ±0.56) ng/ml,and (0.20 ±0.34) ng/ml,respectively.There were significant differences among the three groups ( P ＜ 0.05 ).Conclusion RSV infection occurs mainly in infants of age less than 1 year,Streptococcus pneumoniae and Haemophilus influenzae infection occur mainly in infants of age 1 ～3 years,while MP is the leading cause of pneumonia in children of age more than 6 years in Jiaxing city.We can decide pathogen on ages,clinical manifestation and PCT level to guide the rational use of drugs.
