小儿气管支气管软化症合并肺炎与单纯肺炎呼吸道病原分布特点对比分析

Comparative analysis on distribution of respiratory pathogen between children with tracheobronchomalacia complicated with pneumonia and simple pneumonia

摘要:

目的：研究气管支气管软化症（tracheobronchomalacia，TBM）合并肺炎与单纯肺炎患儿呼吸道病原分布特点的差异性。方法：回顾性分析2012年1月至2016年12月我院收治的TBM合并肺炎患儿（TBM组）及单纯肺炎患儿（NTBM组）各337例的病史及支气管肺泡灌洗液标本病原资料，再进一步以年龄（＜1岁、≥1岁）、肺炎严重程度（重症、非重症）分组进行组间比较。结果：①整体上，TBM组、NTBM组总细菌检出率分别为54.90%、45.99%，差异有统计学意义（P=0.021），前4位细菌均为肺炎链球菌、大肠埃希菌、肺炎克雷伯菌、副流感嗜血杆菌，大肠埃希菌检出率分别为12.17%、4.75%，差异有统计学意义（P=0.001）。②非重症组中，TBM组、NTBM组细菌检出率分别为57.75%、47.62%，大肠埃希菌检出率分别为11.24%、4.40%，肺炎克雷伯菌检出率分别为10.46%、4.40%，差异均有统计学意义（P=0.019，P=0.003，P=0.007）；＜1岁组中，2组大肠埃希菌检出率分别为13.89%、5.31%，差异有统计学意义（P=0.001）。③2组首位病毒为呼吸道合胞病毒，总病毒、呼吸道合胞病毒、肺炎支原体检出率均无统计学意义（P=0.361，P=0.502，P=0.055）；肺炎衣原体未检出。结论：①TBM合并肺炎患儿细菌分布特点较单纯肺炎患儿有差异，大肠埃希菌感染多见，尤其在＜1岁患儿中占首位。②非重症组中，TBM合并肺炎患儿细菌感染较单纯肺炎患儿多见，其中大肠埃希菌检出率明显增加。③两者病毒、肺炎支原体分布特点无差异，肺炎衣原体在本研究中未见。

Abstract:

Objective：To study the difference of respiratory pathogen distribution in children with Tracheobronchomalacia （TBM） complicated pneumonia and children with simple pneumonia. Methods：Retrospectively analyze medical records and bronchoalveolar lavage fluid（BALF） specimen data of two groups，children with tracheobronchomalacia complicated pneumonia which named TBM group and children with simple pneumonia which named NTBM group，from January 2012 to December 2016 in Children’s Hospital of Chongqing Medical University，with 337 cases in each group. According to their age，they were divided into infant group（aged 0 days to 1 year） and young children group（aged 1 to 3 years）. According to the severity of pneumonia，they were divided into severe pneumonia group and non-severe pneumonia group. Then data was compared in groups. Results：①As a whole，in TBM group and NTBM group，the total bacteria positive rate were 54.90% and 45.99%，and with significant difference（P=0.021）. The tops four bacteria were Streptococcus pneumoniae，Escherichia coli，Kleb－siella pneumoniae and Hemophilus parainfluenzae. The positive rate of Escherichia coli were 12.17% and 4.75%，and respec－tively with significant difference（P=0.001） among two groups. ②Considering the non-severe pneumonia group，in TBM group and NTBM group，the positive rate of bacteria were 57.75% and 47.62%，the positive rate of Escherichia coli were 11.24% and 4.40%，and the positive rate of Klebsiella pneumoniae were 10.46% and 4.40%，respectively with significant difference（P=0.019，P=0.003，P=0.007） among two groups. As to bacterial type in infant group，the Escherichia coli ranked first in TBM group and the Strep－tococcus pneumonia ranked first in NTBM group. The Escherichia coli postive rate of two groups were 13.89% and 5.31% re－spectively，with significant difference（P=0.001）. ③Respiratory syncytial virus（RVS） ranked first in TBM group and NTBM group，with no significant difference（P=0.502）. There was no significant difference in total virus positive rate and Mycoplasma pneumonia positive rate between the two groups（P=0.361，P=0.055）. Chlamydia pneumonia positive rate was 0. Conclusion：①Difference in bacterial distribution existed between TBM complicated pneumonia and simple pneumonia. The distribution was the most in Escherichia coli，which ranked first in infant particularly. ②In the non-severe pneumonia group，bacterial infection rate of children with TBM complicated pneumonia was higher than that of children with simple pneumonia，among which the Escherichia coli infection rate was significantly higher. ③In term of the distribution of virus and Mycoplasma pneumonia，there was no significant difference between children with TBM complicated pneumonia and children with simple pneumonia. Chlamydia pneumonia infection was not found in the study.