滕州市痉挛性咳嗽患儿的病原学分析

发布时间：2018-05-28 23:33

本文选题：儿童 + 痉挛性咳嗽　；参考：《山东大学》2014年硕士论文

【摘要】：{背景}中国百日咳流行病学调查项目为中国疾病预防与控制中心在全国流行病学调查项目,在山东省及新疆维吾尔自治区两个点进行调查,其中山东省选择滕州市中心人民医院及莱芜中心医院进行,滕州市中心人民医院儿科负责临床资料收集工作。该项目由山东省疾病预防与控制中心直接负责,由山东省疾病预防与控制中心提供新鲜羊血制作百日咳培养基,专门人员已经由山东省疾病预防与控制中心培训3个月,已经工作近1年时间,PCR方法查百日咳DNA,由我院收集鼻咽拭子,由山东省疾病预防与控制中心直接检测,百日咳抗体检测由我院进行,山东省疾病预防与控制中心进行督导检查,流行病学调查由滕州市疾病预防与控制中心预防保健科进行。 {目的}探讨儿童痉挛性咳嗽的病原学,以利于临床针对性治疗,尤其是百日咳的流行病学调查,为国家制定预防接种政策提供科学的依据。 {方法}针对152例痉挛性咳嗽患儿采用痰培养检测细菌,鼻咽拭子查百日咳培养及PCR法测百日咳DNA(山东省疾病预防控制中心协助完成),抽血查百日咳抗体IgM、IgG,抽血查呼吸道病毒9项(包括肺炎支原体、立克次体、腺病毒、嗜肺军团菌、呼吸道合胞病毒、流感病毒、肺炎衣原体、副流感病毒)IgM,同时部分患儿检查血常规、超敏C反应蛋白、胸部正位片、胸部CT、儿童肺功能检查、过敏原检测等。考虑有气道高反应性的患儿进行支气管舒张试验、呼出气一氧化氮测定(NO)。对照组为非痉挛性咳嗽患儿85例,同时进行百日咳、痰培养、呼吸道病毒九项检测。 {结果}43例咽拭子PCR法查百日咳DNA11例阳性,43例咽拭子百日咳培养均为阴性,114例抽血查百日咳抗体IgM阳性32例(其中5例与PCR法测百日咳DNA共同阳性),百日咳确诊38例,占总病例25%。痰培养阳性7例(包括鲍曼不动杆菌1例、金黄色葡萄球菌1例、肺炎克雷伯菌2例、铜绿假单胞菌1例、白假丝酵母菌2例),肺炎支原体阳性7例,肺炎衣原体阳性3例,腺病毒阳性1例,其中百日咳以五个月以内14例,占百日咳总数的36.8%,5岁以上11例,占百日咳总数的28.9%。病原体检测阳性共为56例,占总病例36.8%。血白细胞2万以上44例占29%,淋巴细胞比例70%以上53例占35%,胸部正位片有支气管炎征象54例,占35.5%,有肺炎征象21例,占13.8%,肺功能检查：FEV1(一秒钟用力呼气容积)、PEF(呼气峰值流速)降低大于20%14例,占9.2%,过敏原检测阳性21例,占13.8%,呼出气一氧化氮(NO)测定：阳性为24例,占15.8%。 {结论}目前儿童痉挛性咳嗽仍以百日咳感染为主,其中以五个月以内及五岁以上为主,与疫苗未接种及接种五年后抗体滴度降低有关,96例患儿(占63.2%)未检测到病原菌,可能与检测设备及技术、以及患儿为其他原因引起的咳嗽有关。患儿其他原因的咳嗽包括咳嗽变异性哮喘、感染后咳嗽、上气道咳嗽综合征等各种疾病。
[Abstract]:{background} the China pertussis Epidemiology Survey Project is the National Epidemiological investigation Project of the China Center for Disease Prevention and Control. It has been investigated at two points in Shandong Province and Xinjiang Uygur Autonomous region. Shandong Province selected Tengzhou central people's hospital and Laiwu central hospital to carry out the pediatrics of Tengzhou central people's hospital was responsible for clinical data collection. The project is under the direct responsibility of the Shandong Center for Disease Prevention and Control, which provides fresh sheep blood for making pertussis media. The specialized personnel have been trained by the Shandong Center for Disease Prevention and Control for three months. It has been working for nearly one year to check the pertussis DNA by PCR method. Nasopharynx swabs were collected by our hospital, directly detected by the Shandong Disease Prevention and Control Center, the pertussis antibody test was carried out by our hospital, and the Shandong Disease Prevention and Control Center conducted supervision and inspection. The epidemiological investigation was carried out by the Department of Prevention and Health of the Center for Disease Prevention and Control in Tengzhou City. Objective: to explore the etiology of spastic cough in children in order to provide scientific basis for clinical targeted treatment, especially epidemiological investigation of pertussis. {methods} sputum culture was used to detect bacteria in 152 children with spastic cough. Rhinopharynx swab test pertussis culture and PCR method to measure pertussis DNA (Shandong Centers for Disease Control and Prevention assisted in completing pertussis, blood samples for pertussis antibody IgMN IgG, blood samples for 9 items of respiratory viruses (including Mycoplasma pneumoniae, Rickettsiae, adenovirus, Legionella pneumophila), Respiratory syncytial virus, influenza virus, chlamydia pneumoniae, parainfluenza virus IgM. At the same time, blood routine examination, hypersensitive C-reactive protein, chest radiograph, chest CTS, pulmonary function test, allergen test, etc. Bronchodiastolic test was performed in children with airway hyperresponsiveness and nitric oxide in exhaled air was measured. In the control group, 85 children with non-spastic cough were examined for pertussis, sputum culture and respiratory virus. {results} there were 43 cases of pertussis DNA11 positive by throat swab PCR method and 43 cases of throat swab pertussis culture were all negative in 114 cases of pertussis antibody IgM positive (5 cases were positive with PCR method to detect pertussis DNA, 38 cases of pertussis were diagnosed. Accounting for 25% of the total cases. Sputum culture was positive in 7 cases, including Acinetobacter baumannii 1 case, Staphylococcus aureus 1 case, Klebsiella pneumoniae 2 cases, Pseudomonas aeruginosa 1 case, Candida albicans 2 cases, Mycoplasma pneumoniae 7 cases, Chlamydia pneumoniae 3 cases. One case was positive for adenovirus, of which 14 cases were pertussis within five months, accounting for 36.8% of the total pertussis, 11 cases were over 5 years old, accounting for 28.990% of the total pertussis. 56 cases were positive for pathogens, accounting for 36.8% of the total cases. The proportion of lymphocytes was over 70% in 53 cases (35 cases), bronchitis signs in 54 cases (35%), pneumonia signs in 21 cases (54 cases) in positive chest radiographs, the proportion of white blood cells was above 20 000 in 44 cases, and the proportion of lymphocytes was over 70% in 53 cases (35%). Lung function examination: FEV1 (forced expiratory volume in one second) decreased more than 20 cases (9.2%), allergen was positive in 21 cases (13.8%) and exhaled nitric oxide (no) was detected in 24 cases (15.8%). {conclusion} at present, pertussis infection is still the main cause of spastic cough in children, especially within 5 months and over five years of age. No pathogenic bacteria were detected in 96 children (63.2%) who were not vaccinated and the antibody titer decreased five years after inoculation. May be related to testing equipment and technology, as well as cough caused by other causes in the child. Other causes of cough include cough variant asthma, postinfection cough, upper airway cough syndrome and so on.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.6

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