大理地区小儿肺炎呼吸道九种病原体检测及意义

发布时间：2018-10-14 13:00

【摘要】：目的：通过对在大理州医院儿科就诊治疗的小儿肺炎的病原学检测结果进行分析,了解大理地区小儿肺炎的病原学流行情况，指导临床合理用药。方法：对276例肺炎患儿在疾病初期，采用间接免疫荧光法测定五种呼吸道病毒:呼吸道合胞病毒(Respiratorysyncytialvirus,RSV)、甲型流感病毒(InfluenzaAvirus,IFVA)、乙型流感病毒(InfluenzaBvirus,IFVB)及副流感病毒（Parainfluenzavirus,PIV）、腺病毒(Adenovirus,ADV)；四种非典型病原体包括：肺炎支原体（mycoplasmapneumonia,MP）、肺炎衣原体（Chlamydiapneumonia,CPn）、嗜肺军团菌1型（Legionellapneumopilatype1,LP1）、Q热立克次体(Richettsiaquery,QFR）共九种病原的抗体。检查结果的例数，用SPSS13.0软件包进行统计处理，通过卡方检验，比较九种病原体在不同年龄组的流行情况以及与季节、居住地、性别相关的流行特点。结果：在受检的276例患儿中，病原体抗体呈阳性的有121例，占43.8%（121/276）；其中呼吸道病毒抗体阳性25例，，占9.1%（25/276）；单项五种常见呼吸道病毒占6.9%（19/276），并以乙型流感病毒为主，占4.3%（12/276）。非典型病原体抗体阳性的有58例，占21.0%（58/276），单项四种非典型病原体抗体阳性为54例，占19.6%（54/276），其中以支原体为主，占18.8%（52/276）。38例混合感染（病毒和非典型病原体的混合感染）中，以肺炎支原体合并其他病毒感染为主，占10.9%（30/276）。病毒、非典型病原体及混合感染在婴儿组、幼儿组、儿童组之间差异显著，具有统计学意义(P0.05)。婴儿组病毒检出率高于幼儿组、儿童组(P0.05)；病毒、非典型病原体及混合感染在夏秋及冬春季的流行有差异，表现为冬春季高于夏秋季(P0.05)；病毒、非典型病原体及混合感染的分布与居住地域有关，城镇的患儿，非典型病原体及混合感染高于农村，差异有统计学意义(P0.05)；病毒、非典型病原体及混合感染与患儿性别无关。病毒感染常见于冬春季，以1岁以下的婴幼儿多见，农村并高于城镇；四种常见非典型病原体感染以支原体为主，混合感染以肺炎支原体合并其他病毒感染为主，均好发于冬春季，主要见于3岁以上的儿童,且城镇高于农村。结论：1、大理地区，五种常见呼吸道病毒、四种非典型病原体、病毒和非典型病原体混合感染在小儿肺炎的病原体中占有一定的比例，其中单项常见呼吸道病毒以乙型流感病毒感染为主。四种非典型病原体中，单项感染以肺炎支原体感染为主。混合感染（病毒和非典型病原体的混合感染），肺炎支原体合并其他病毒感染占10.9%（30/276）。2、病毒、非典型病原体、病毒和非典型病原体的混合感染流行还与年龄、季节、居住地域有关。3、通过检测呼吸道常见的九种病原体的IgM抗体可明确小儿肺炎五种病毒和四种非典型病原体在本地区感染情况，为临床合理用药提供指导性意义。
[Abstract]:Objective: to analyze the etiological detection results of pediatric pneumonia in Dali Hospital, to understand the etiological prevalence of pediatric pneumonia in Dali area, and to guide the rational use of drugs in clinic. Methods: five respiratory viruses, respiratory syncytial virus (Respiratorysyncytialvirus,RSV), influenza A virus (InfluenzaAvirus,IFVA), influenza B virus (InfluenzaBvirus,IFVB), parainfluenza virus (Parainfluenzavirus,PIV) and adenovirus (Adenovirus,ADV), were detected by indirect immunofluorescence assay in 276 children with pneumonia at the early stage of the disease, including respiratory syncytial virus (Respiratorysyncytialvirus,RSV), influenza A virus (InfluenzaAvirus,IFVA), influenza B virus (InfluenzaBvirus,IFVB) and parainfluenza virus (Parainfluenzavirus,PIV). Four types of atypical pathogens include mycoplasma pneumoniae (mycoplasmapneumonia,MP), chlamydia pneumoniae (Chlamydiapneumonia,CPn) and Legionella pneumophila type 1 (Richettsiaquery,QFR). The results were analyzed by SPSS13.0 software package and chi-square test was used to compare the prevalence of nine pathogens in different age groups and the epidemic characteristics related to season, residence and sex. Results: among 276 children tested, 121 (43.8%) were positive for pathogen antibody, 25 (9.1%) were positive for respiratory virus antibody (25 / 276), 6.9% (19 / 276) for single common respiratory virus, and 4.3% (12 / 276) for influenza B virus. There were 58 (21.0%) (58 / 276) of atypical pathogens positive, 54 (19.6%) (54 / 276) of single four atypical pathogens, in which mycoplasma accounted for 18.8% (52 / 276). 38 cases of mixed infections (virus and atypical pathogens). Mycoplasma pneumoniae combined with other viruses was the main infection, accounting for 10.9% (30 / 276). Virus, atypical pathogens and mixed infection were significantly different among infant group, infant group and child group (P0.05). The detection rate of infantile virus was higher than that of infant group (P0.05); the prevalence of virus, atypical pathogen and mixed infection in summer and autumn was higher than that in summer and autumn (P0.05). The distribution of atypical pathogens and mixed infections was related to the living area, the children in urban areas, atypical pathogens and mixed infections were significantly higher than those in rural areas (P0.05); viruses, atypical pathogens and mixed infections were not related to the gender of children. Virus infection was common in winter and spring, mostly in infants under one year old, in rural areas and higher than in urban areas, four common atypical pathogens were mainly mycoplasma, and mixed infections were mainly mycoplasma pneumoniae combined with other viruses. Both occurred in winter and spring, mainly in children over 3 years old, and higher in towns than in rural areas. Conclusion: 1. In Dali area, five common respiratory viruses, four atypical pathogens, and mixed infection of virus and atypical pathogen account for a certain proportion of the pathogens of pneumonia in children. One of the most common respiratory viruses is influenza B virus infection. Among the four atypical pathogens, the single infection was mycoplasma pneumoniae infection. Mixed infection (mixed infection of virus and atypical pathogen), mycoplasma pneumoniae combined with other virus infection accounted for 10.9% (30 / 276). 2. Virus, atypical pathogen, virus and atypical pathogen of mixed infection prevalence also associated with age, season, By detecting the IgM antibodies of nine common pathogens in respiratory tract, the infection of five viruses and four atypical pathogens in children's pneumonia can be determined in this area, which provides guidance for rational use of drugs in clinic.
【学位授予单位】：大理学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.6

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