社区获得性肺炎患者联合监测肺炎支原体与肺炎衣原体的临床意义

目的 探讨联合监测肺炎支原体(Mp)和肺炎衣原体(Cp)对社区获得性肺炎(CAP)患者的临床意义.方法 选取2012年2月至2014年10月我院收治的CAP患者1 580例,监测患者咽拭子标本中Mp、Cp,培养并鉴定其主要病原菌,比较不同抗感染方案的疗效.结果 CAP病原体以Mp (30.0%)、肺炎链球菌(15.9%)、流感嗜血杆菌(12.9%)、Cp (10.1%)比例最高,且同时合并2种病原体感染者较为多见(10.1%);治疗中β-内酰胺类药物使用频率最高(76.71%);β-内酰胺类联合大环内酯类或联合氟喹诺酮类药物对CAP治愈率(66.72%)显著高于单独应用β-内酰胺类药物治疗(56.73%,P<0.01);单用β-内酰胺类药物治疗与应用β-内酰胺类联合氟喹诺酮类(65.4%)或大环内酯类药物(68.5%)对单纯Mp或Cp感染CAP治愈率比较差异均无统计学意义(P>0.05),而在细菌合并Mp或Cp感染时,联合用药治愈率(69.7%)明显高于单用β-内酰胺类药物(44.4%),差异有统计学意义(P<0.05).结论 CAP患者感染Mp与Cp较多见,β-内酰胺类药物是常用治疗药物,β-内酰胺类联合大环内酯类或氟喹诺酮类药物可提高患者治愈率,Mp与Cp联合检测对于敏感抗生素的选择及疗效的提高具有重要临床意义.     

肺炎支原体肺炎患儿急性期和恢复期血浆H-ficolin和L-ficolin水平分析

目的了解肺炎支原体肺炎患儿急性期和恢复期血浆中H-ficolin、L-ficolin水平的变化。方法采用ELISA法检测85例肺炎支原体肺炎患儿急性期和恢复期血浆H-ficolin、L-ficolin水平,并进行相关性分析。结果急性期H-ficolin水平1.8~25.2μg/ml,平均（11.9±5.9）μg/ml,恢复期H-ficolin水平0.3~26.5μg/ml,平均（10.1±5.7）μg/ml,急性期明显高于恢复期（Z=2.161,P=0.031）。急性期L-ficolin水平0.2~10.6μg/ml,平均（4.5±2.3）μg/ml,恢复期L-ficolin水平0.03~10.2μg/ml,平均（4.6±2.2）μg/ml,急性期和恢复期无统计学差异（t=0.245,P=0.807）。患儿急性期血浆H-ficolin水平与L-ficolin水平明显相关（r=0.22,P=0.039）。结论H-ficolin可能参与儿童肺炎支原体肺炎疾病过程。     

女性生殖道支原体及衣原体感染对妊娠的影响

目的：探讨女性生殖道支原体及衣原体感染对妊娠的影响。方法选择2012年7月至2015年7月处于妊娠期发生衣原体及支原体感染的202例产妇,将其作为感染组,其中120例为治疗组,其余82例为未治疗组,另外选取同时间段内于我院进行产检的未发生生殖道感染的185例孕妇作为对照组。比较对照组与感染组孕产妇、围产儿合并症发生情况;治疗组与未治疗组孕产妇、围产儿合并症发生情况。结果感染组出现流产、早产、宫内生长受限、未足月胎膜早破、死胎死产、产褥病、低体重儿及新生儿肺炎发生率均显著高于对照组(P＜0.05);治疗组流产、早产、宫内生长受限、未足月胎膜早破、死胎死产、产褥病、低体重儿及新生儿肺炎发生率均显著低于未治疗组(P＜0.05)。结论女性生殖道支原体及衣原体感染对妊娠结局产生不良影响,应注意加强产前检查,及时治疗,改善妊娠结局。     

Detection of Mycoplasma species in cell culture by PCR and RFLP based method: effect of BM-cyclin to cure infections

PURPOSE: A two-stage nested polymerase chain reaction (PCR) assay system was described that amplifies the 16S-23S rRNA spacer region sequences of Mycoplasma and Acholeplasma infections in cell cultures and virus stocks. METHODS: Established cell lines and virus stocks were screened for the presence of Mycoplasma by using nested PCR using two sets of outer and inner primers, amplifies 16S-23S rRNA. PCR and restriction fragment length polymorphism (RFLP) assay was used to detect and identify most of the species-specific Mycoplasmas involved in cell cultures and virus stock contaminants. Infected cultures detected by PCR-RFLP were further treated with BM-cyclin (5 microg/mL) and passaged for three times and tested for Mycoplasma infections by PCR-RFLP. RESULTS: Mycoplasma pirum and Mycoplasma orale infections were detected by nested PCR. Species specificity was identified by using RFLP of Vsp I, Cla I and Hin dIII restriction enzymes. Mycoplasma infections were cured by treatment with BM-cyclin. This was further confirmed by non-amplification of PCR amplimers in BM-cyclin treated vs. non-treated cultures. CONCLUSIONS: Regular monitoring of cell cultures for Mycoplasma infections and identification of species-specific Mollicutes will identify the source of contaminations. This approach can be used for quality control of the biological reagents used in cell culture and virology laboratories.     

婴幼儿肺炎支原体肺炎的临床特点及预后分析

目的分析婴幼儿肺炎支原体肺炎(MPP)的临床特点及预后,发现区别并为其早期识别提供理论依据。方法选取2013年2月-2017年5月在宁海县第一医院儿科住院治疗的诊断为婴幼儿MPP的80例患儿,根据年龄分为<1岁组(20例)和1~3岁组(60例)。记录患儿的临床表现,进行特异性肺炎支原体(MP)-Ig M检测。比较两组患儿的临床表现、实验室检查结果及肺外并发症发生率。结果两组患儿发热发生率、热峰、热程,喘鸣音发生率,血常规结果,胸片检查结果比较差异均有统计学意义(均P<0.05)。两组患儿肺外并发症发生率、治愈率比较差异均无统计学意义(P>0.05)。逐步回归分析发现:入院时体温、肺外并发症及血清MP-Ig M抗体滴度对住院天数有显著影响(均P<0.05)。结论与幼儿期相比,婴儿期对炎症刺激反应较弱,应针对MPP婴幼儿做到早期迅速诊断,进行有效治疗,防止疾病蔓延造成不良后果。     

糖皮质激素辅助治疗难治性肺炎支原体肺炎的Meta分析

目的:系统评价糖皮质素辅助治疗难治性肺炎支原体肺炎的疗效。方法:检索PubMed、Medline、Embase、Cochrane 图书馆、中国生物医学文献数据库、中国知网、万方数据库及维普数据库,检索时间从建库至2017年5月31日,收集糖皮质激素治疗儿童难治性肺炎支原体肺炎的RCT文献。应用RevMan 5.3软件进行Meta分析。结果:共纳入9篇RCT文献(n =920)。激素治疗后,试验组总有效率、住院时间、退热时间、肺部阴影消失时间与对照组比较差异有统计学意义(P<0郾01)。各研究文献住院时间、退热时间存在异质性。结论:糖皮质激素辅助治疗难治性肺炎支原体肺炎能提高疗效,缩短住院时间、退热时间、肺部阴影消失时间。     

儿童难治性肺炎支原体肺炎临床及实验室检查特征分析

[摘要]目的:研究早期判别难治性肺炎支原体肺炎(RMPP)的特征性临床表现及干预措施。方法:收集2013年10月至2014年9月在苏州大学附属儿童医院住院治疗并确诊为RMPP的63例患儿(RMPP组)以及采用抽签法抽取同期住院治疗的32例普通MPP患儿(MPP组)的临床特征及实验室检查资料,进行比较研究。结果:RMPP组患儿平均年龄高于MPP组(P<0.01),热程(16.17±4.60)d长于MPP组的(6.97±1.77)d(P<0.01);RMPP组患儿大叶性肺炎、呼吸音减低及肺部叩诊浊音、胸腔积液、肝脏损伤的发生率均高于MPP组(P均<0.05);RMPP组MP鄄DNA拷贝数高于MPP组(P<0.01);RMPP组外周血中WBC、中性粒细胞计数及 LDH、IgG、IgA、IgM水平均高于MPP组(P均<0.05);RMPP组CRP>40 mg/L及ALT升高发生率均高于MPP组(P均<0.05);RMPP组使用支气管镜冲洗治疗的比例高于MPP组,使用大环内酯类抗生素1个疗程后退热时间及住院时间明显长于MPP组(P均<0.01)。结论:RMPP易发生于大年龄儿童,更易出现大叶性肺部炎症,MP鄄DNA 拷贝数高,热程长,CRP>40 mg/L的比例高,胸腔积液、肝脏受损发生率高,需要支气管镜冲洗治疗的比例高,住院时间长。     

The pulmonary virome,bacteriological and histopathological findings in bovine respiratory disease from western Canada

The aetiology and pathogenesis of bovine respiratory disease (BRD) are complex and involve the interplay of infectious agents, management and environmental factors. Previous studies of BRD focused on ante‐mortem samples from the upper respiratory tract and identified several unconventional viruses. The lung, however, is the primary location where significant BRD lesions are usually found and is a common post‐mortem diagnostic specimen. In this study, results of high‐throughput virome sequencing, bacterial culture, targeted real‐time PCR and histological examination of 130 bovine pneumonic lungs from western Canadian cattle were combined to explore associations of microorganisms with different types of pneumonia. Fibrinous bronchopneumonia (FBP) was the predominant type of pneumonia (46.2%, 60/130) and was associated with the detection of Mannheimia haemolytica. Detection of Histophilus somni and Pasteurella multocida was associated with suppurative bronchopneumonia (SBP) and concurrent bronchopneumonia and bronchointerstitial pneumonia (BP&BIP), respectively. Sixteen viruses were identified, of which bovine parvovirus 2 (BPV2) was the most prevalent (11.5%, 15/130) followed by ungulate tetraparvovirus 1 (UTPV1, 8.5%, 11/130) and bovine respiratory syncytial virus (BRSV, 8.5%, 11/130). None of these viruses, however, were significantly associated with a particular type of pneumonia. Unconventional viruses such as influenza D virus (IDV) and bovine rhinitis B virus (BRBV) were detected, although sparsely, consistent with our previous findings in upper respiratory tract samples. Taken together, our results show that while virus detection in post‐mortem lung samples is of relatively little diagnostic value, the strong associations of H. somni and M. haemolytica with SBP and FBP, respectively, indicate that histopathology can be useful in differentiating bacterial aetiologies.     

166例支气管哮喘急性发作期患儿呼吸道病原学分析

目的：了解东莞市儿童支气管哮喘急性发作期的病原学分布特征,指导临床治疗。方法：选择东莞市太平人民医院2012年6月至2013年6月收治住院的支气管哮喘急性发作患儿共166例,根据年龄分为〈3岁婴幼儿组和≥3岁儿童组,分别检测病毒、支原体（MP）、衣原体（CP）及细菌等病原体分布情况。结果：166例患儿检出病毒、MP、CP、细菌感染任何一项阳性者共132例,占79.5%,其中检出病毒69例（41.6%）、CP 16例（9.6%）、MP 39例（23.5%）,细菌培养阳性39例（23.5%）。结论：东莞市儿童哮喘急性发作与感染密切相关,病毒感染最多见,MP、细菌感染亦较常见。     

小儿肺炎支原体感染的临床检验特点

目的：总结小儿发生肺炎支原体感染的临床表现以及临床检验特点,提高临床诊断水平。方法对2013年1月～2014年1月收治的156例小儿肺炎支原体感染患者进行临床检验分析,所有患者均接受酶联免疫吸附剂测定（ELISA）肺炎支原体IgM抗体检验（MP-IgM）,被动凝集法检验,以及血常规、尿常规、血生化、血气分析、细菌培养等各项常规检查。结果分析和总结临床检验结果,发现MP-IgM检测法和被动凝集法具有较高的特异性,阳性率分别为39.1%和37.2%,二者差异无统计学意义（P＞0.05）。其他各项常规检查缺乏特异性。结论对可疑肺炎支原体感染患儿应进行早期实验室检查并结合影像学及其临床表现进行综合分析,及早确诊,MP-IgM检测法和被动凝集法具有较高的特异性。