作者：王丽1，于玉梅2，邓清秀1

单位：

1.061000河北省沧州市中心医院儿内四科　2.061000河北省沧州市中心医院儿内三科

Units：

1.Fourth Department of Pediatrics, Cangzhou Central Hospital, Cangzhou 061000, China2.Third Department of Pediatrics, Cangzhou Central Hospital, Cangzhou 061000, China

关键词：

社区获得性肺炎；儿童；病原体；临床特征

Keywords：

Community acquired pneumonia; Children; Etiology; Clinical characteristics

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.199

Funds：

河北省医学科学研究课题计划（20211649）

摘要：

目的　分析儿童社区获得性肺炎（CAP）的病原体分布及临床特征。方法　选取2020年10月至2021年9月在沧州市中心医院儿童院区住院治疗的儿童CAP 494例。记录所有患儿的临床特征（包括性别、年龄、发病季节及病情严重程度），分析所有患儿病原体检出情况，并比较不同临床特征患儿混合感染发生率及病原体检出率。结果　494例患儿中447例检出病原体，病原体检出率为90.5%，其中单一感染355例（占79.4%）、混合感染92例（占20.6%）。447例患儿共检出病原体543株，其中病毒最多，占58.4%，其次为肺炎支原体（占23.0%）、细菌（占16.2%）、衣原体（占2.4%）。0~1岁、＞1~3岁患儿混合感染发生率分别高于＞3~6岁、≥7岁患儿（P ＜0.05）；秋季发病患儿混合感染发生率低于春季、夏季发病患儿（P ＜0.05）。男性患儿肺炎克雷伯菌检出率低于女性患儿，肺炎支原体检出率高于女性患儿（P ＜0.05）。随着年龄增长，患儿病毒、巨细胞病毒、呼吸道合胞病毒、副流感病毒、流感嗜血杆菌检出率呈下降趋势，肺炎链球菌、肺炎支原体检出率呈上升趋势（P ＜0.05）。秋季、冬季发病患儿病毒检出率分别高于春季、夏季发病患儿，冬季发病患儿病毒检出率高于秋季发病患儿（P ＜0.05）；冬季发病患儿肺炎支原体检出率分别低于春季、夏季发病患儿（P ＜0.05）。重症患儿鼻病毒、流感嗜血杆菌检出率高于轻症患儿（P ＜0.05）。结论　病毒仍是儿童CAP的主要病原体，其次为肺炎支原体；儿童CAP混合感染者占比较高，尤其是0~3岁儿童；随着年龄增长，患儿病毒感染率降低、肺炎支原体感染率升高；病毒感染多见于秋冬季，而肺炎支原体感染多见于春夏季；鼻病毒感染导致的儿童CAP容易进展为重型CAP。

Abstract：

Objective　To analyze the pathogen distribution and clinical characteristics of children with community acquired pneumonia in (CAP) . Methods　A total of 494 children with CAP who were hospitalized in Children's Hospital ofCangzhou Central Hospital from October 2020 to September 2021 were selected. Clinical characteristics (including gender,age, onset season and severity of disease) of all children were recorded, pathogen detection of all children was analyzed, andthe incidence of mixed infection and pathogen detection rate of children with different clinical characteristics were compared.Results　Pathogen was detected in 447 of 494 children, with the detection rate of 90.5%, including 355 cases (79.4%) of singleinfection and 92 cases (20.6%) of mixed infection. A total of 543 strains of pathogen were detected in 447 children, among whichvirus was the most, accounting for 58.4%, followed by mycoplasma (23.0%) , bacteria (16.2%) and chlamydia (2.4%) . Theincidence of mixed infection in children aged 0-1 years old and > 1-3 years old was higher than that in children aged > 3-6years old and ≥ 7 years old (P < 0.05) . The incidence of mixed infection in autumn was lower than that in spring and summer (P< 0.05) . The detection rate of Klebsiella pneumoniae in male children was lower than that in female children, and the detectionrate of mycoplasma was higher than that in female children (P < 0.05) . With the increase of age, the detection rates of virus,cytomegalovirus, respiratory syncytial virus, parainfluenza virus and Haemophilus influenza showed a downward trend, whilethe detection rates of Streptococcus pneumoniae and mycoplasma showed an upward trend (P < 0.05) . The virus detection rate inautumn- and winter-onset children was higher than that in spring- and summer-onset children , and the virus detection rate inwinter-onset children was higher than that in autumn-onset children (P < 0.05) . The detection rate of mycoplasma in winter-onsetchildren was lower than that in spring- and summer-onset children (P < 0.05) . The detection rates of rhinovirus and Haemophilusinfluenzae in severe children were higher than those in mild children (P < 0.05) . Conclusion　Virus is still the main pathogen ofCAP in children, followed by mycoplasma. The proportion of CAP children with mixed infection is relatively high, especially in 0-3years old children. With the increase of age, the infection rate of virus of children decreases, and mycoplasma of children increases.Virus infection is more common in autumn and winter, while mycoplasma infection is more common in spring and autumn. Childrenwith CAP caused by hinovirus infection is easy to progress to severe CAP.

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