摘要
目的探讨小儿急性上呼吸道感染病原学的检测方法及宝鸡地区小儿急性上呼吸道感染的病原谱。方法对宝鸡市5家医院儿科2010年8月至2011年7月小儿急性呼吸道感染病原学多中心调查时收集到的小儿急性上呼吸道感染的病原学检测资料进行汇总分析。结果5436例小儿急性上呼吸道感染咽拭子超高倍显微镜检结果分析显示阳性率为70．0％，其中细菌20．0％、肺炎支原体或衣原体35．0％、混合感染15．0％，镜检阴性率30．0％。小儿急性上呼吸道感染咽分泌物病原核酸检测结果显示肺炎支原体核酸、EB病毒核酸、呼吸道合胞病毒核酸、柯萨奇病毒A16核酸、肠道病毒7l核酸、肠道病毒普通型阳性率依次为12．1％、23．6％、7．8％、4．3％、0、10．1％，病毒核酸总阳性率为45．8％，阳性率最高的病毒是EB病毒，其次是肠道病毒普通型、呼吸道合胞病毒、柯萨奇病毒A16，各病毒在各年龄段感染率无明确规律，但呼吸道合胞病毒最多见于1岁以内的小儿。1745例小儿急性上呼吸道感染咽拭子肺炎支原体培养阳性率为16．0％。848例小儿急性上呼吸道感染咽拭子细菌培养结果阳性率24．9％，共培养出17种细菌，前6位致病菌为肺炎链球菌12．0％，溶血性链球菌3．5％，肺炎克雷伯杆菌2．9％，卡他莫拉菌2．5％，大肠埃希斯杆菌1．1％，金黄色葡萄球菌0．8％，肺炎链球菌占第1位且为绝对优势致病菌，在5岁以内感染率最高。结论各检测方法可检测病原的种类、敏感性、特异性、时效性不同，所以提倡多方法、多病原的联合检测。多中心联合检测结果显示宝鸡地区小儿急性上呼吸道感染的病原谱为病毒占45．8％为主，其次是细菌、肺炎支原体、混合感染、其他如衣原体等感染，临床医师诊治小儿急性上呼吸道感染应根据病原体检测结果结合临床表现合理选用抗生素。
Objective To investigate the test methods of acute upper respiratory infections （AURI） and the pathogenic spectrum of AURI in Baoji children. Methods The pathogen test data of AURI collected from August 2010 to July 2011 from pediatric department of 5 hospitals in Baoji city was analyzed. Results The multimedia microscopy examination of throat swab of 5 436 cases with AURI showed that the positive rate was 70.0%, including 20.0% of bacteria, 35.0% of mycoplasma pneumoniae or chlamydia, 15.0% of mixed infection and 30.0% of microscopy-negative rate. The pathogenic nucleic acids （ PCR-fluorescent probe method ） test resuhs of pharyngeal secretions of children with AURI revealed the positive rates of mycoplasma pneumoniae （ MP-DNA ） , Epstein-Barr virus nucleic acid （EBV-DNA）, respiratory syncytial virus nucleic acid （RSV-RNA） , Coxsackie A1 6 virus nucleic acid （CVA16-RNA）, enterovirus 71 nucleic acid （EV71-RNA） and the common type of enterovirus were 12.1%, 23.6%, 7.8% 4.3%, 0 and 10.1%, respectively. The total positive rate of viral nucleic acid was 45.8%, and the virus with highest positive rate was EBV, followed by common type of intestinal virus, RSV and CVA16. There was no obvious rule for infection rate at various ages for each virus, but RSV was most frequently found in children younger than 1. The positive rate of mycoplasma pneumoniae culture of throat swab of 1 745 children with AURI was 16.0%. The positive rate of bacterial culture of 848 cases was 24.9%, and altogether 17 kinds of bacteria were cultured. The first 6 kinds of pathogenic bacteria were streptococcus pneumoniae （ 12.0% ） , hemolytic streptococcus （ 3.5% ）, Klebsiella pneumoniae （ 2. 9% ）, moraxelle catarrhialis （2.5 % ）, colon Aixi Si bacilli （ 1.1% ） and staphylococcus aureus （0.8%）. Streptococcus pneumoniae ranked at first place and it was absolute predominant pathogenic bacterium, the infection rate of which was highest in children within 5 years of age. Conclusion The types of pathogens defected, sensitivity, specificity and timeliness of different detection methods are different, and combined detection with different methods and pathogens is promoted. This muhicenter combining detection shows that virus （45.8%） is major pathogen in the pathogenic spectrum of children with AURI in Baoji, followed by bacteria, mycoplasma pneumoniae, mixed infection, and others such as chlamydial infection. In clinics, diagnosis and treatment of AURI should be based on the pathogenic results and clinical manifestations so as to choose rational antibiotics.
出处
《中国妇幼健康研究》
2012年第3期314-317,共4页
Chinese Journal of Woman and Child Health Research
关键词
小儿
急性上呼吸道感染
病原谱
多中心
children
acute upper respiratory infections （AURI）
pathogenic spectrum
multicenter
