1 788例社区获得性肺炎非细菌性病原体分布特征分析

Distribution of non-bacterial pathogens in 1 788 children with community-acquired pneumonia

摘要:

目的 探讨社区获得性肺炎患儿非细菌性病原体分布特点。方法 回顾性选取2021年12月—2022年11月于沈阳市儿童医院住院的社区获得性肺炎患儿1 788例，运用多重RT-PCR与毛细电泳联用技术对10种病毒病原体及2种非典型病原体进行检测，同时抽取静脉血行肺炎衣原体、肺炎支原体血清学抗体检测，分析不同病原体的分布特征。结果 （1）1 788例社区获得性肺炎患儿病原体阳性率为72.43%（1 295/1 788），其中病毒病原体阳性率为59.68%（1 067/1 788），非典型病原体阳性率为22.04%（394/1 788）。阳性率由高到低依次为肺炎支原体、呼吸道合胞病毒、流感病毒B、偏肺病毒、鼻病毒、副流感病毒、流感病毒A、博卡病毒、腺病毒、肺炎衣原体、冠状病毒。（2）季节分布：春季以呼吸道合胞病毒、肺炎支原体为主要病原体；夏季以肺炎支原体阳性率最高，其次为流感病毒A；秋季偏肺病毒阳性率最高；冬季主要为流感病毒B、呼吸道合胞病毒。（3）性别、年龄分布：肺炎支原体阳性率女孩高于男孩（P<0.05），其他病原体性别比较差异无统计学意义（P>0.05）。部分病原体在不同年龄组间的阳性率不同（P<0.05）：肺炎支原体阳性率在>6岁组最高；呼吸道合胞病毒和肺炎衣原体阳性率在<1岁组最高；偏肺病毒、流感病毒B阳性率在1~<3岁组最高。（4）疾病分布：重症肺炎患儿以呼吸道合胞病毒、肺炎支原体、鼻病毒、偏肺病毒为主；大叶性肺炎患儿的病原体主要为肺炎支原体；急性支气管肺炎前5位病原体为肺炎支原体、流感病毒B、偏肺病毒、呼吸道合胞病毒、鼻病毒。结论 肺炎支原体、呼吸道合胞病毒、流感病毒B、偏肺病毒、鼻病毒为儿童社区获得性肺炎的主要非细菌性病原体；呼吸道病原体阳性率在不同年龄阶段、季节和性别间存在一定差异。 ［中国当代儿科杂志，2023，25（6）：633-638］

Abstract:

Objective To investigate the distribution characteristics of non-bacterial pathogens in community-acquired pneumonia (CAP) in children.Methods A total of 1 788 CAP children admitted to Shenyang Children's Hospital from December 2021 to November 2022 were selected. Multiple RT-PCR and capillary electrophoresis were used to detect 10 viral pathogens and 2 atypical pathogens, and serum antibodies of Chlamydial pneumoniae (Ch) and Mycoplasma pneumoniae (MP) were detected. The distribution characteristics of different pathogens were analyzed.Results Among the 1 788 CAP children, 1 295 children were pathogen-positive, with a positive rate of 72.43% (1 295/1 788), including a viral pathogen positive rate of 59.68% (1 067/1 788) and an atypical pathogen positive rate of 22.04% (394/1 788). The positive rates from high to low were MP, respiratory syncytial virus (RSV), influenza B virus (IVB), human metapneumovirus (HMPV), human rhinovirus (HRV), human parainfluenza virus (HPIV), influenza A virus (IVA), bocavirus (BoV), human adenovirus (HADV), Ch, and human coronavirus (HCOV). RSV and MP were the main pathogens in spring; MP had the highest positive rate in summer, followed by IVA; HMPV had the highest positive rate in autumn; IVB and RSV were the main pathogens in winter. The positive rate of MP in girls was higher than that in boys (P<0.05), and there were no significant differences in other pathogens between genders (P>0.05). The positivity rates of certain pathogens differed among age groups (P<0.05): the positivity rate of MP was highest in the >6 year-old group; the positivity rates of RSV and Ch were highest in the <1 year-old group; the positivity rates of HPIV and IVB were highest in the 1 to <3 year-old group. RSV, MP, HRV, and HMPV were the main pathogens in children with severe pneumonia, while MP was the primary pathogen in children with lobar pneumonia, and MP, IVB, HMPV, RSV, and HRV were the top 5 pathogens in acute bronchopneumonia.Conclusions MP, RSV, IVB, HMPV, and HRV are the main non-bacterial pathogens of CAP in children. There are certain differences in the positive rates of respiratory pathogens among children of different ages, genders, and seasons. Citation:Chinese Journal of Contemporary Pediatrics, 2023, 25(6): 633-638