门诊急性呼吸道感染患儿肺炎支原体、衣原体病原学监测及临床意义

摘要 目的 了解门诊急性呼吸道感染患儿中肺炎支原体（MP）和肺炎衣原体(CPn）的病原学情况。方法 定期选择首都儿科研究所儿内科门诊临床拟诊急性呼吸道感染的患儿行咽拭子MP、CPn的nPCR检测。共纳入314例患儿，其中男183例，女131例，年龄2个月至14岁。结果 314例患儿中MP和CPn阳性50例，总阳性率15.9％（50/314）。其中MP感染46例，阳性率14.6％（46/314）；CPn感染4例，阳性率1.3％（4/314）。男女感染比例1.3∶1。感染患儿年龄为4个月至12岁。MP感染并发呼吸道病毒感染占MP感染的21.7％（10/46）；其中90.0％（9/10）为急性上呼吸道感染。本组MP感染患儿临床表现以发热、咳嗽和流涕为主，个别有头痛、肌痛及胃肠道症状；有8例（17.4％，8/46）患儿仅以发热、扁桃体红肿为体征就诊。4例CPn感染患儿均有发热，伴有咳嗽和流涕。所观察的MP、CPn感染以急性上呼吸道感染为主，占80.0％(40/50)。MP感染以冬、春季节发病较高，并存在混合感染。CPn感染为9、10和12月份散发。结论 MP和CPn感染也是儿科急性上呼吸道感染中的重要病原之一。发病年龄有小年龄化趋势。MP、CPn感染与其他病原体所致呼吸道感染在临床上并无特殊之处。采用nPCR的方法，可以提供早期病原学诊断的依据。

Monitoring of pneumonia mycoplasma and pneumonia chlamydia in children with acute respiratory Infection in pediatric out -patient departement

Objective To investigate the infection status of pneumonia mycoplasma (MP) and pneumonia chlamydia (CPn) in children with acute respiratory-tract infection in pediatric out-patient department. Methods The pharyngal samples of children suspected with acute respiratory-tract infection in out-patient department were collected for detecting the MP and CPn by nest PCR. In total, 314 cases aged from 2 months to 14 years were detected, including 131 females and 183 males. Results Among 314 cases, 50 cases were positive for MP or CPn, the positive infection rate of MP or CPn was 15.92%. Among 50 positive cases, 46 (16.6% of all cases) infected with MP and 4 with CPn (1.3% of all cases). The ratio of male and female infected cases was 1.3∶1. The infected children aged from 4 months to 12 years. Among 46 cases infected with MP, 10 (21.7%) were complicated with respiratory virus infection, most of whom (9/10, 90%) with acute upper respiratory infection. The major clinical symptoms of MP infected cases were fever, cough and running nose, but only few cases had headache, muscle pain and gastrointestinal symptoms. Eight patients were with fever and tonsil rankle. The blood routine tests of infected cases showed that white blood cell counts and CRP were normal and neutrophils accounted for 52.2%. All 4 children infected with CPn had fever accompanied by running nose. Among 50 cases infected with MP or CPn, most of them (40/50) showed acute upper respiratory infection, in addition 22 (44%) were younger than 3 years old and 18 (36%) were 3 to 12 years old. Lower respiratory tract infection was shown with the rate of 12% and 8% in children younger than 3 years old and 3 to 12 years old, respectively. The MP infection rate was higher in Spring and in Winter than in other two seasons. CPn was easily infected on September, October and December, but in sporadic. Conclusions MP and CPn infection are the important pathogens of pediatric acute respiratory infection. Infected children get younger and younger. MP and CPn infection do not have specific symptoms compared to other pathogen infection. Earlier pathogen diagnosis by nPCR can guide earlier proper treatment.