618例小儿重症社区获得性肺炎病原谱及临床特点分析

目的了解长春地区住院重症社区获得性肺炎病原谱及临床特点,为其病原学诊断和针对性治疗提供科学依据。方法2016年1月至2019年12月长春市儿童医院住院的618例临床诊断为重症社区获得性肺炎患儿,采集患儿咽拭子和肺泡灌洗液标本。应用病毒分离、细菌培养、飞行时间质谱和PCR/RT-PCR技术检测标本中的核酸和蛋白质谱。结果住院重症社区获得性肺炎患儿男性多于女性。发病高峰年龄段为7~12月龄小儿。发病多集中在冬春季。重症社区获得性肺炎病毒检出率最高,为56.15%(347/618);检出一种病毒病原阳性73.49%(255/347),其中前5位的是呼吸道合胞病毒(27.8%)、甲型流感病毒(23.9%)、乙型流感病毒(16.1%)、鼻病毒(12.2%)和偏肺病毒(10.2%);两种病毒阳性19.88%(69/347);3种病毒阳性4.32%(15/347);4种病毒阳性2.31%(8/347)。非典型微生物感染占29.77%(184/618),其中肺炎支原体感染占95.65%(176/184)。细菌感染17.31%(107/618),以肺炎链球菌(39.25%,42/107)和金黄色葡萄球菌(24.30%,26/107)为主。多种病原混合感染7.61%(47/618),其中肺炎支原体和肺炎链球菌、病毒混合感染分别为40.43%和34.04%。高热、呼吸增快和口周发绀是重症社区获得性肺炎的危险因素(OR值和95%CI分别为7.71和4.56~13.04、2.43和2.02~2.93、3.53和2.56~4.86);病毒混合感染36.96%(34/92)出现心力衰竭、中毒性脑病、心肌损害等并发症;肺炎支原体与其他病原混合感染35.29%出现胸腔积液。结论长春地区重症社区获得性肺炎的病原以病毒为主,呼吸道合胞病毒是优势病原,肺炎支原体次之,细菌病原以肺炎链球菌为主。高热、呼吸增快和口周发绀是重症肺炎的危险因素。多病原混合感染易出现严重并发症。

Analysis of etiology and clinical characteristics of 618 children with severe community-acquired pneumonia

Objective To understand the etiology and clinical characteristics of hospitalized severe community-acquired pneumonia(SCAP)in Changchun,and provide scientific basis for its etiology diagnosis and targeted treatment.Methods The study subjects included 618 children with clinical diagnosis of SCAP who were hospitalized from January 2016 to December 2019.We collected pharyngeal swabs and alveolar lavage fluid from children.Virus isolation,bacterial culture,time-of-flight mass spectrometry,PCR/RT-PCR,colloidal gold method and Optochin test were used to detect the antigen,nucleic acid and protein profiles in the specimen.Results There were more boys than girls in hospitalized children with SCAP.The peak age of onset was 7 to 12 months.Most cases occurred in winter and spring.The highest detection rate of SCAP virus was 56.15%(347/618);73.49%(255/347)were positive for one virus,among which the top five were respiratory syncytial virus(27.8%),influenza A virus(23.9%),influenza B virus(16.1%),rhinovirus(12.2%)and metapneumovirus(10.2%).Two viruses were positive for 19.88%(69/347);three viruses were positive for 4.32%(15/347);four viruses were positive for 2.31%(8/347).Atypical microbial infections were 29.77%(184/618),of which Mycoplasma pneumoniae accounted for 95.65%(176/184).Bacterial infections were 17.31%(107/618),mainly Streptococcus pneumoniae(39.25%,42/107)and Staphylococcus aureus(24.30%,26/107).The mixed infection of multiple pathogens was 7.61%(47/618),among which the mixed infection rates of Mycoplasma pneumonia with Streptococcus pneumoniae,virus were 40.43%and 34.04%,respectively.High fever,faster breathing,and perioral cyanosis were risk factors for SCAP,with OR and 95%CI of 7.71 and 4.56-13.04,2.43 and 2.02-2.93,3.53 and 2.56-4.86,respectively.Viral co-infection occurred in 36.96%(34/92)of complications such as heart failure,toxic encephalopathy,and myocardial damage;Mycoplasma pneumoniae and other pathogens co-infected 35.29%of children with pleural effusion.Conclusion The pathogens of SCAP in Changchun are mainly viruses notably,respiratory syncytial virus is the dominant pathogen,followed by Mycoplasma pneumoniae.The bacterial pathogen is mainly Streptococcus pneumoniae.High fever,faster breathing,and cyanosis around the mouth are risk factors for severe pneumonia.Multi-pathogen mixed infection is prone to serious complications.