CAJ | 학술논문

目的调查迁延性咳嗽(咳嗽≥2周)的未免疫或未完全免疫婴幼儿博德特百日咳杆菌感染情况.方法 2011年1月1日至2012年12月31日,采用前瞻性研究方法对首都儿科研究所附属儿童医院就诊或收治的迁延性咳嗽(咳嗽≥2周)未免疫及未完成全程免疫患儿采集呼吸道分泌物及血清,分别采用多重PCR方法及酶联免疫吸附试验(ELISA)检测博德特百日咳杆菌及博德特百日咳杆菌毒素抗体,收集患儿的临床及流行病学资料.结果入组患儿176例,百日咳博德特菌感染率29.0％ (51/176),百日咳多重PCR检测阳性51例,血清学检测阳性18例.51例百日咳患儿年龄23d～4岁,＜1岁者46例(90.2％),≥1岁者5例(9.8％)；男31例,女20例.＜1岁未接种百白破疫苗婴儿35例,其中＜3个月龄者31例,3 ～ 12个月龄4例；＜1岁未完成全程接种11例；≥1岁5例患儿均未接种.百日咳春夏季发病较多,秋冬发病较少.9例患儿有家庭内咳嗽患者接触史,与其接触的有慢性咳嗽家庭成员12例,检测百日咳血清抗体阳性12例,百日咳多重PCR阳性3例.百日咳重症、有合并症患儿15例(15/51,29.4％),合并症包括重症肺炎、呼吸衰竭、脑病,腹股沟斜疝嵌顿等.结论博德特百日咳杆菌感染是未免疫或未获得完全免疫的婴幼儿迁延性咳嗽的重要致病因素之一；百日咳发病以春夏为多；百日咳感染婴儿病情重,合并症发生率高；未诊断的成人或年长儿百日咳可能是婴儿的重要传染源.百日咳杆菌多重PCR检测快速、敏感,可用于临床早期诊断.
목적 조사천연성해수(해수≥2주)적미면역혹미완전면역영유인박덕특백일해간균감염정황.방법 2011년1월1일지2012년12월31일,채용전첨성연구방법대수도인과연구소부속인동의원취진혹수치적천연성해수(해수≥2주)미면역급미완성전정면역환인채집호흡도분비물급혈청,분별채용다중PCR방법급매련면역흡부시험(ELISA)검측박덕특백일해간균급박덕특백일해간균독소항체,수집환인적림상급류행병학자료.결과 입조환인176례,백일해박덕특균감염솔29.0％ (51/176),백일해다중PCR검측양성51례,혈청학검측양성18례.51례백일해환인년령23d～4세,＜1세자46례(90.2％),≥1세자5례(9.8％)；남31례,녀20례.＜1세미접충백백파역묘영인35례,기중＜3개월령자31례,3 ～ 12개월령4례；＜1세미완성전정접충11례；≥1세5례환인균미접충.백일해춘하계발병교다,추동발병교소.9례환인유가정내해수환자접촉사,여기접촉적유만성해수가정성원12례,검측백일해혈청항체양성12례,백일해다중PCR양성3례.백일해중증、유합병증환인15례(15/51,29.4％),합병증포괄중증폐염、호흡쇠갈、뇌병,복고구사산감돈등.결론 박덕특백일해간균감염시미면역혹미획득완전면역적영유인천연성해수적중요치병인소지일；백일해발병이춘하위다；백일해감염영인병정중,합병증발생솔고；미진단적성인혹년장인백일해가능시영인적중요전염원.백일해간균다중PCR검측쾌속、민감,가용우림상조기진단.
Objective To explore the prevalence of Bordetella pertussis (B.pertussis) infection in unvaccinated or incomplete vaccinated infants with cough for a prolonged duration.Methods The serum samples and nasopharyngeal secretions were collected from 176 patients with cough for a prolonged duration (≥2 weeks) from 2011 to 2012 at Children's Hospital Affiliated to Capital Institute of Pediatrics.Multiplex PCR of nasopharyngeal secretion was employed to identify B.pertussis.And enzyme-linked immunosorbent assay(ELISA) was used to detect antibody to pertussis toxin (PT-IgG).Total bacterial DNA was exacted from nasopharyngeal secretion and two-target IS481/PT of B.pertussis was detected by PCR.The sera and nasopharyngeal secretions were also collected from household contacts with cough for a prolonged duration.Their clinical characteristic and epidemiological profiles were collected and analyzed.Results B.Pertussis infection was demonstrated in 51 cases (29.0％).The patients ages were from 23 days to 4 years.Among them,46 cases (90.2％) were aged under 12 months and 5 cases (9.8％) over 12 months.And40 cases were unvaccinated (31 cases ＜ 3 months old,4 cases 3-12 months old,5 cases ＞ 5 years old) and 11 cases incompletely vaccinated.There were 31 males and 20 females.More patients were found in spring and summer than those in autumn and winter.Nine infant cases had 12 household contacts.Among 12 household contacts,3 were PCR positive and 12 PT-IgG positive.Pertussis was remarkably critical in infants.Serious complications included failure to thrive,pneumonia,respiratory failure and seizures.Conclusions B.pertussis infection is an important cause in unvaccinated or incomplete vaccinated infants with prolonged cough.Peak seasons of pertussis are spring and summer.Undiagnosed adolescents and adults with pertussis may be a significant source for transmission of B.pertussis to other susceptible children.Infants aged under 1 year are at risk for severe pertussis and life-threatening complications.As a rapid and sensitive method of detecting B.pertussis,PCR may be used in early phase.