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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (10) : 959 -964. doi: 10.3877/cma.j.issn.1674-0785.2022.10.007

临床研究

肺炎患儿呼吸道病原检出特点及与PM 2.5浓度相关性分析
李远哲1, 杨德彬1, 霍蓓蓓1,(), 胡文洁1, 丁显飞2   
  1. 1. 450018 河南郑州,郑州大学附属儿童医院呼吸科
    2. 450052 河南郑州,郑州大学第一附属医院重症医学科
  • 收稿日期:2021-08-10 出版日期:2022-10-15
  • 通信作者: 霍蓓蓓
  • 基金资助:
    河南省医学科技攻关联合共建项目(LHGJ20190908); 河南省医学科技攻关联合共建项目(LHGJ20220720)

Characteristics of respiratory pathogen detection in children with pneumonia and correlation with PM2.5 concentration

Yuanzhe Li1, Debin Yang1, Beibei Huo1,(), Wenjie Hu1, Xianfei Ding2   

  1. 1. Department of Respiratory Medicine, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
    2. Department of Critical Care Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
  • Received:2021-08-10 Published:2022-10-15
  • Corresponding author: Beibei Huo
引用本文:

李远哲, 杨德彬, 霍蓓蓓, 胡文洁, 丁显飞. 肺炎患儿呼吸道病原检出特点及与PM 2.5浓度相关性分析[J/OL]. 中华临床医师杂志(电子版), 2022, 16(10): 959-964.

Yuanzhe Li, Debin Yang, Beibei Huo, Wenjie Hu, Xianfei Ding. Characteristics of respiratory pathogen detection in children with pneumonia and correlation with PM2.5 concentration[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(10): 959-964.

目的

了解社区获得性肺炎(CAP)住院患儿呼吸道病原体的检出特点、临床特征并分析与空气污染物PM2.5浓度的相关性。

方法

收集郑州大学附属儿童医院2019年1月至2020年12月1192例住院的CAP患儿痰标本,采用荧光定量PCR法检测9种临床常见呼吸道病原体核酸,包括:肺炎链球菌(SP)、大肠埃希氏菌(EC)、金黄色葡萄球菌(SA)、流感嗜血杆菌(HI)、嗜肺军团菌(LP)、铜绿假单胞菌(PA)、肺炎克雷伯菌(KP)、肺炎支原体(MP)、肺炎衣原体(CP)并分析检出情况,同时实时记录郑州市同期空气PM2.5浓度。

结果

病原体总检出阳性率为42.6%,其中最常见革兰氏阳性菌为SP,最常见革兰氏阴性菌为HI;四季中,冬季检出率最高;婴幼儿组肺炎患儿下呼吸道病原中,SP及HI检出率高于学龄前期组及学龄期组患儿,而学龄期组患儿MP检出率高于婴幼儿组及学龄前期组患儿(P<0.05);重度肺炎机械通气组患儿SP、PA及MP检出率高于重度肺炎非机械通气组及轻度肺炎组,差异有统计学意义(P<0.05);重度肺炎患儿单一SP、PA及MP感染的3组间分类比较发现,在临床表现中咳嗽、呼吸急促/呼吸困难、实验室检查中CK-MB及ALT以及肺部影像学中肺实变及胸腔积液组间差异具有统计学意义(P<0.05);调查期间空气污染物PM 2.5浓度处于波动状态,PM 2.5浓度与SP、HI、MP及PA检出率均呈正相关(r=0.858、0.673、0.723、0.591,P均<0.05)。

结论

SP、HI、MP为郑州地区CAP患儿感染的重要病原体,婴幼儿检出率高,四季中冬季检出率最高,夏季最低;不同病原体引起肺炎的严重程度以及临床特征、实验室检查、影像学表现存在差异,其检出率与空气污染物PM2.5浓度水平密切相关。

Objective

To investigate the characteristics and clinical characteristics of respiratory pathogens in hospitalized children with community acquired pneumonia (CAP), and analyze their correlation with the concentration of air pollutant PM2.5.

Methods

Sputum specimens from 1192 hospitalized children at Children's Hospital of Zhengzhou University from January 2019 to December 2020 were collected, and nine clinically common respiratory pathogens were detected by fluorescent quantitative PCR, including Streptococcus pneumoniae (SP), Escherichia coli (EC), Staphylococcus aureus (SA), Haemophilus influenzae (HI), Streptococcus pneumoniae (LP), Streptococcus pneumoniae (PA), Klebsiella pneumoniae (KP), Mycoplasma pneumoniae (MP), and Chlamydia pneumoniae (CP). Air PM2.5 concentrations in Zhengzhou were recorded in real time.

Results

The total detection rate for pathogens was 42.6%; the most common Gram-positive organism was SP and the most common Gram-negative organism was HI. Among the four seasons, the detection rate was the highest in winter. Among the lower respiratory pathogens of pneumonia in children, the detection rates for SP and HI were higher in the infant and toddler group than in the preschool and school-age groups, while the detection rate for MP was higher in the school-age group than in the infant and toddler and preschool groups (P<0.05). The detection rates for SP, PA, and MP were significantly higher in the mechanically ventilated patients with severe pneumonia than in the non-mechanically ventilated patients with severe pneumonia and patients with mild pneumonia (P<0.05). When comparing single SP, PA, and MP infections in children with severe pneumonia, it was found that there were statistically significant differences in the clinical manifestations of cough, shortness of breath/dyspnea, laboratory results of CK-MB and ALT, and pulmonary consolidation and pleural effusion on pulmonary imaging (P<0.05). PM2.5 concentrations of air pollutants were fluctuating during the investigation period, and PM2.5 concentrations were positively correlated with SP, HI, MP, and PA detection rates (r=0.858, 0.673, 0.723, and 0.591, respectively; P<0.05 for all).

Conclusion

SP, HI, and MP are important pathogens among children with CAP in Zhengzhou, with high detection rates in infants and children. The detection rate is highest in winter and lowest in summer among the four seasons. The severity of pneumonia caused by different pathogens as well as clinical features, laboratory tests, and imaging manifestations differ, and their detection rates are closely related to the concentrations of air pollutants PM2.5.

表1 病原体检出情况(n=508)
表2 不同年龄阶段肺炎患儿不同病原体检出情况[例(%)]
表3 不同严重度肺炎患儿病原体检出情况[例(%)]
表4 不同病原体感染重度肺炎患儿临床特征的比较[例(%)]
表5 不同病原体感染重度肺炎患儿实验室检查比较(
xˉ±s
表6 不同病原体感染重度肺炎患儿肺部影像学检查比较[例(%)]
图1 SP、HI、MP、PA检出率与空气污染物浓度PM2.5浓度相关性 注:SP为肺炎链球菌;HI为流感嗜血杆菌;MP为肺炎支原体;PA为铜绿假单胞菌
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