成都地区住院儿童难治性社区获得性非典型肺炎的多中心临床分析

目的 通过住院病儿社区获得性肺炎（Community-acquired pneumonia,CAP）和难治性社区获得性肺炎（Refractory Community-acquired pneumonia,RCAP）非典型病原体（Atypical pathogens,AP）感染的比较,了解成都地区难治性社区获得性非典型肺炎住院儿童的感染状况和特点,为RCAP的预防和治疗提供依据.方法 采用间接免疫荧光法（MIF）时315例儿童难治性社区获得性非典型肺炎和普通社区获得性肺炎住院患儿的血清标本进行肺炎支原体（Mycoplasma pneumoniae,MP）、肺炎衣原体（Chlamydia pneumoniae,CP）和军团菌（Legionella pneumoniae,LP）和多种检测方法栓测其它病原微生物,根据检测结果进行对比和分析.结果 在163例儿童难治性社区获得性非典型肺炎共检测出典型病原体阳性36例,检出率22.09％,MP、LP、CP阳性率分别为14.11％、4.91％和4.29％.CAP中病原体阳性53例,检出率34.87％,MP、LP、CP阳性率分别为23.68％、6.57％和5.26％.非典型病原体在全年均可发病,感染率秋、冬季最高,其中肺炎支原体低于同期CAP的检出率,36例RCAP非典型病原体阳性患儿与其它病原混合感染者16例（44.44％）,非典型病原体和其它2种病原菌混合感染5例（13.88％）,非典型病原体间混合感染2例（5.55％）.在RCAP非典型病原体检测阳性的患儿有并发症出现17例（47.22％）,CAP的10例（18.86％％）.两组在发热率、发热和咳嗽持续时间、平均住院日和联合抗感染治疗率上有显著差异（P＜0.05）.结论 儿童难治性社区获得性非典型肺炎的住院患儿非典型病原体是主要病原体,肺炎支原体感染有较低的检出率,低于普通社区获得性肺炎;RCAP中混合感染、并发症是导致RCAP的原因之一.

Clinical analysis of refractory community-acquired pneumonia children hospitalized infection by atypical pneumonia in Chengdu

Objective To recognize the clinical characteristics of refractory community-acquired pneumonia （RCAP） hospitalized children patients infected by three kinds of atypical pathogens through Comparison of community-ac- quired pneumonia and refractory community-acquired （CAP） pneumonia in Chengdu region. Methods Based on indirect immunofluorescence （MIF） assay, simultaneously detected blood IgM levels of Mycoplasma pneumoniae （MP）,L-pneu- moniae（LP） and Chlamydia pneumoniae （CP） from 163 RCAP and 152 CAP hospitalized children patients between 2010and 2011 ,so that acquired statistics results through investigations of the age and gender distribution characteristics, of atypical pathogen infection and of the epidemiologieal features of the two years＇results. Results 163 cases of children with refractory community-acquired atypical pneumonia were detected out typical pathogens positive in 36 cases in Cheng- du region between the year2010 and 2011 The combined infection rate was22.09%, MP, LP , CP positive rates were 14. 11%, 4.91% and 4.29%, respectively. CAP were found in 55 cases, the detection rate of 34.87%, MP, LP the CPpositive rate was 23.06%, 7.23% and 5.92%, respectively. In autumn and winter the infection rates were the highest. Atypical pathogen was the main local causative agent responsible for RCAP and CAP children. MP infection in RCAP is lower than the same period in CAP, 36 cases refractory community-acquired pneumonia of atypical pathogens positive children with mixed infection with other pathogens in 16 cases （44.44%）. The atypical pathogens mixed infections in 2 cases （5. 55%）. Atypical pathogens and other two mixed pathogen infection in 5 cases （13. 88%. Complications oc- curred in 17 patients （47.22%） of RCAP were higher than in 10 cases （18.86%） of CAP. Conclusion Atypical patho- gen was the major pathogen responsible for RCAP and CAP children. Detection rate of Mycoplasma pneumoniae infection in RCAP was lower than that of in CAP. Infection and complications were some of the reasons lead RCAP.