中国实用儿科杂志

中国实用儿科杂志

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儿童百日咳合并感染临床研究

  

  1. 1.苏州市立医院东区儿科， 江苏  苏州  215003；2.苏州大学附属儿童医院 a呼吸科， b检验科， 江苏  苏州  215003
  • 出版日期:2018-09-06 发布日期:2018-09-19

Study of mixed coinfections in children with pertussis

  1. *Department of Pediatrics，the East Area of Suzhou Municipal Hospital，Suzhou 215003，China
  • Online:2018-09-06 Published:2018-09-19

摘要：

目的　探讨百日咳患儿合并感染的临床特点。 方法　收集2016年2月至2017年9月苏州大学附属儿童医院因疑诊百日咳而住院治疗的患儿，进行痰博德特百日咳杆菌聚合酶链反应（PCR）检测、细菌培养、呼吸道病毒抗原及血清肺炎支原体抗体检测。 结果　共有198例患儿纳入研究，其中105例患儿百日咳PCR检测阳性， 单纯感染37例（35.2%）， 合并其他病原感染68例（64.8%）。其中合并1种病原者51例（75.0%），前3位依次为鼻病毒26例（50.9%）、 肺炎支原体7例（13.7%）、 肺炎链球菌6例（11.8%）。各年龄合并感染率比较差异无统计学意义（P＝0.08），合并支原体感染随着年龄增长而增加。合并感染组的患儿年龄比单纯感染组大［（11.77±2.31）个月 vs. （6.74±8.07）个月，P＝0.017］，发热、呼吸困难和肺部阳性体征的比例均高于单纯感染组（0 vs. 10.3%；20.6% vs. 5.4%；76.5% vs. 36.4%）；胸部影像学大多表现为斑片状影，而外周血白细胞总数、中性粒细胞计数、C反应蛋白、入院前病程及住院时间比较差异均无统计学意义（均P ＞0.05）。年龄＞3个月（OR＝3.0，95%CI 1.1～8.5，P＝0.03）和发热（OR＝2.5，95%CI 1.1～6.7，P＝0.03）是合并感染的独立危险因素。结论　百日咳住院患儿存在较高的合并感染率，以鼻病毒最常见，其次为肺炎支原体和肺炎链球菌；合并感染会加重百日咳病情，发热和年龄＞3个月是合并感染发生的高危因素。

关键词: 百日咳杆菌, 儿童, 混合感染, 临床特征

Abstract:

Objective　To explore the clinical characteristics of coinfections in children with pertussis. Methods　From February 2016 to September 2017，198 cases with pertussis-like symptom were tested for PCR，bacterial culture，respiratory virus antigen and serum mycoplasma pneumoniae antibody in Children’s Hospital of Soochow University. Results　Totally 198 patients were enrolled and 105 patients were B.Pertussis positive. Single infection was in 37 cases（35.2%）. Coinfections were observed in 68（64.8%） children with pertussis，including co-infection with one pathogen in 51 cases（75.0%）. The most frequent co-infection pathogen was rhinovirus（50.9%，26 cases），followed by Mycoplasma pneumoniae（13.7%，7 cases） and Streptococcus pneumoniae（11.8%，6 cases）. There was no statistical difference in the coinfection rate among different age groups（P = 0.08）. Pertussis coinfection with MP was increased with age. Coinfections patients were older than those with single infections［（11.77±2.32） months vs. （6.74±8.07） months，P = 0.017］. Fever，dyspnea，and positive signs of lung in chest imang were more common in children with mixed infections（0 vs. 10.3%；20.6% vs. 5.4%；76.5% vs. 36.4%，P＜0.05）. Chest imaging showed pathy shadow in most cases. There was no significant difference in lab tests，such as white blood cell counts，neutrophil counts，C-reactive protein（CRP），course of disease prior to admission or hospital stay between patients with pertussis only and those with mixed-pathogen infections（P＞0.05）. Patients older than 3 months（OR＝3.0，95%CI 1.1-8.5，P＝0.03） and fever（OR＝2.5，95%CI 1.1-6.7，P＝0.03） were the independent risk factors for mixed infections. Conclusion　There is a higher proportion of coinfection in hospitalized children with pertussis，most commonly co-infected with rhinovirus，followed by Mycoplasma pneumoniae and Streptococcus pneumoniae. Coinfections are found to aggravate pertussis. Fever and being older than 3 months are risk factors of mixed infection.

Key words: Bordetella pertussis, child, coinfection, clinical characteristics