天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (4): 313-319.doi: 10.11958/20192626

• 流行病学调查 • 上一篇    下一篇

2013—2018年天津地区住院儿童急性呼吸道感染病原体流行特征分析 #br#

宗晓龙 1，马利锋 2，李真玉 3，韩悦 1，田雨鑫 1，赵琪 1，魏殿军 4△
  

  1. 1天津医科大学第二医院检验科（邮编 300211），2儿科，3重症医学科；4河北燕达医院检验科
  • 收稿日期:2019-08-26 修回日期:2019-10-28 出版日期:2020-04-15 发布日期:2020-06-23
  • 通讯作者: 魏殿军 E-mail:wei_dj007@163.com
  • 作者简介:宗晓龙（1983），男，硕士，主管技师，主要从事感染性疾病与宿主反应的检验诊断及机制研究
  • 基金资助:
    天津市卫生计生行业高层次人才选拔培养工程“青年医学新锐”人才项目；天津医科大学第二医院青年科研基金（2019ydey28）

Analysis on the epidemic characteristics of respiratory pathogens in hospitalized children with#br# acute respiratory tract infections in Tianjin from 2013 to 2018 #br#

ZONG Xiao-long1, MA Li-feng2, LI Zhen-yu3, HAN Yue1, TIAN Yu-xin1, ZHAO Qi1, WEI Dian-jun4△ #br#   

  1. 1 Department of Laboratory, 2 Department of Pediatric, 3 Department of Critical Care Medicine, the Second Hospital of Tianjin
    Medical University, Tianjin 300211, China; 4 Laboratory of Yanda Hospital of Hebei
  • Received:2019-08-26 Revised:2019-10-28 Published:2020-04-15 Online:2020-06-23
  • Contact: WEI Dian-jun E-mail:wei_dj007@163.com

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摘要： 目的 分析 2013—2018年天津地区急性呼吸道感染（ARI）住院儿童的病原谱及其流行特征。方法 采集
痰和/或咽拭子标本行细菌培养鉴定；采集血清样本行 9 种呼吸道病原体 IgM 抗体联合检测，包括甲型流感病毒
（IFA）、乙型流感病毒（IFB）、副流感病毒（PIVs）、呼吸道合胞病毒（RSV）、腺病毒（ADV）、嗜肺军团菌 1型（LP-1）、Q热立克次体（COX）、肺炎衣原体（CPn）、肺炎支原体（MP），同时检测血清 MP抗体滴度（≥1∶160定义为阳性）。结果 共纳入 ARI住院患儿 7 832例，其中 5 353例完成细菌培养鉴定，7 449例完成 9种呼吸道病原体 IgM抗体及 MP抗体滴度检测，4 970例完成上述所有病原学检查。7 832例患儿中 3 291例至少检测到 1种病原体，病原总检出率为 42.0%
（3 291/7 832）；细菌总检出率 20.1%（1 078/5 353），以肺炎链球菌（5.3%）、肺炎克雷伯菌（4.0%）、大肠埃希菌（2.7%）、金黄色葡萄球菌（1.9%）、流感嗜血杆菌（1.6%）检出率较高；病毒总检出率为 4.31%（321/7449），以 IFB（2.8%）、PIVs（0.6%）常见；非典型病原体检出率 30.0%（2 241/7 449），以 MP（29.3%）检出率最高。不同性别、季节、年龄段、疾病类
型之间病原检出率有所不同。4 970例完成全部病原学检查的患儿中 379例检测到 2种以上病原体，合并感染检出率
为 7.6%（379/4 970），其中非典型病原体合并细菌、非典型病原体合并病毒、细菌合并病毒感染检出率分别为 3.8%
（191/4 970）、3.0%（150/4 970）、0.6%（28/4 970）；Logistic回归分析显示，在校正年龄、性别因素后，合并感染是普通肺炎进展为重症肺炎的独立风险因素（OR=1.916；95%CI：1.415~2.595；P＜0.01）。结论 2013—2018年天津地区 ARI住院患儿 MP单独及合并感染检出率均较高，且近年有增高趋势；肺炎链球菌、肺炎克雷伯菌、大肠埃希菌、金黄色葡
萄球菌、流感嗜血杆菌是儿童 ARI的常见致病菌；合并感染是疾病进展加重的独立危险因素。

关键词: 急性呼吸道感染, 肺炎, 病原学, 儿童, 流行病学

Abstract: Objective To explorer the profile and epidemiological characteristics of hospitalized children with acute
respiratory tract infection (ARI) in Tianjin, china, from 2013 to 2018. Methods Sputum and/or throat swab specimen and
serum sample were obtained from children within 24 hours after admission. Respiratory bacteria were identified by
biochemical reaction and Analytical Profile Index. IgM antibodies against nine common respiratory pathogens including
influenza virus A (IFA), influenza virus B (IFB), parainfluenza virus serotype 1,2,3 (PIVs), respiratory syncytial virus (RSV),
adenovirus (ADV), mycoplasma pneumonia (MP), chlamydia pneumonia(CP), coxiella burnetii (COX) and legionella
pneumophila serogroup 1 (LP-1) were detected by indirect immunofluorescence antibody test (IFAT). Total antibodies
against MP were further semi-quantified by passive particle agglutination test (PPAT), titer ≥ 1∶160 was confirmed as recent infection. Results A total of 7 832 children hospitalized with ARI were included in the study, of whom 5 353 children were completed bacterial identification, 7 449 children were performed with IFAT and PPAT, and 4 970 children with all above etiological tests. Of the 7 832 children enrolled in the study, 3 291 (42.0%) were positive for one or more pathogen. Twenty percent of the 5 353 patients were performed with bacterial identification with at least one bacterium. The top five common
bacteria were streptococcus pneumoniae (5.3%), Klebsiella pneumoniae (4.0%), Escherichia coli (2.7%), staphylococcus aureus (1.9%) and haemophilus influenzae (1.6%) respectively. Among the five tested viruses, IFB (2.8%) and PIVs (0.6%) were the most commonly identified. MP was the most commonly detected pathogen throughout the year, with a mean positive rate of 29.3% (2 241/7 449) and the seasonal peak form September to December. The presences of more than one pathogen were found, atypical pathogenic/bacterial, atypical pathogenic/viral and bacterial/viral combinations were detected in 3.8, 3.0 and 0.6% respectively. Logistic regression analysis showed that co-infection was independently associated with the increased risk of progression to severe pneumonia (OR=1.916；95%CI: 1.415-2.595；P＜0.01). Conclusion This study suggests that MP and co-infection combined pathogen are the most commonly identified pathogen in the hospitalized children with ARI from 2013 to 2018, with a rising tendency in recent years. S. pneumoniae, K. pneumoniae, E. coli, S. aureus and H. influenzae are commonly indentified bacteria in children with severe lower respiratory tract infection. Co-infection is associated with the increased risk for progression and exacerbation of illness.

Key words: acute respiratory tract infection, pneumonia, etiology, children, epidemiology

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