2011-2018年苏州市住院儿童肺炎的常见病原分布及流行特征

徐鑫鑫; 陈立凌; 田健美; 诸俊; 林玉尊; 王胤; 高君枚; 邵雪君; 张涛; 张钧; 赵根明

doi:10.16462/j.cnki.zhjbkz.2020.03.004

2011-2018年苏州市住院儿童肺炎的常见病原分布及流行特征

doi: 10.16462/j.cnki.zhjbkz.2020.03.004

1.
200032 上海, 复旦大学公共卫生学院流行病学教研室, 公共卫生安全教育部重点实验室
2.
215000 苏州, 苏州市疾病预防控制中心传染病预防控制科
3.
215003 苏州, 苏州大学附属儿童医院

基金项目: 中美新发和再发传染病合作项目(5U2GGH000018);第四轮公共卫生三年行动计划重点学科建设项目(15GWZK0101);苏州卫生和计划生育委员会民生科技关键技术(SS201870)

详细信息

通讯作者:
赵根明, E-mail:gmzhao@shmu.edu.cn

中图分类号: R181.2
计量
- 文章访问数: 161
- HTML全文浏览量: 155
- PDF下载量: 35
- 被引次数: 0
出版历程
- 收稿日期: 2019-08-12
- 修回日期: 2019-12-04
- 刊出日期: 2020-03-10

Analysis on distribution and epidemic characteristics of common pathogens of pneumonia among hospitalized children, Suzhou, 2011-2018

1.
Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
2.
Department of Infectious Disease Prevention and Control, Suzhou Center for Disease Control and Prevention, Suzhou 215000, China
3.
Children's Hospital Affiliated to Suzhou University, Suzhou 215003, China

Funds: China-U.S.Collaborative Program on Emerging and Re-emerging Infectious Diseases(5U2GGH000018); The Fourth Round Three-year Plan of Shanghai Leading Public Health Discipline Project(15GWZK0101); Key Technologies of Science and Technology for People's Livelihood of Suzhou Health and Family Planning Commission(SS201870)

More Information

Corresponding author: ZHAO Gen-ming, E-mail:gmzhao@shmu.edu.cn

摘要

摘要: 目的了解苏州市住院儿童肺炎的病原分布特点及流行特征。方法以2011年4月-2018年3月入住苏州大学附属儿童医院呼吸科的临床肺炎住院儿童为对象, 采集鼻咽分泌物, 对儿童肺炎常见的细菌和病毒病原进行检测。结果 4 765名临床肺炎病例中, 病原检出阳性3 602例(75.6%), 细菌检出阳性2 736例(57.4%), 阳性率最高的为肺炎链球菌(Streptococcus pneumoniae, SP)(20.3%), 其次为流感嗜血杆菌(Haemophilus influenzae, H.i)(15.5%); 病毒检出阳性2 101例(44.1%), 阳性率最高的为呼吸道合胞病毒(respiratory syncytial virus, RSV)(16.4%), 其次为博卡病毒(bocavirus, BoV)(13.6%)。细菌和病毒混合感染1 235例(25.9%), 最主要类型为呼吸道合胞病毒和肺炎链球菌、博卡病毒和草绿色链球菌(Streptococcus viride, SV)。结论 SP、H.i、RSV、BoV是临床肺炎最主要的病原, 病原分布在月龄、季节上存在统计学差异, 细菌和病毒混合感染率较高。
- 住院儿童 /
- 临床肺炎 /
- 病原分布
Abstract: Objective To understand the distribution and epidemic characteristics of common pathogens of pneumonia among hospitalized children in Suzhou. Methods Nasopharyngeal secretions were collected from hospitalized children with clinical pneumonia admitted to the respiratory department of Children's Hospital Affiliated to Suzhou University from April 2011 to March 2018 to detect common viral and bacterial pathogens of children's pneumonia. Results The total positive rate of pathogens was 75.6% in the 4 765 clinical pneumonia cases. The positive rate of bacterial pathogens was 57.4%. Streptococcus pneumoniae(SP) was the highest, followed by Haemophilus influenzae(H.i); The positive rate of viral pathogens was 44.1%. Respiratory syncytial virus(RSV) was the highest, followed by Bocavirus(BoV). The mixed infection rate of bacteria and virus was 25.9%, and the most common types were RSV and SP, BoV and Streptococcus viride(SV). Conclusions SP, H.i, RSV and BoV are the main pathogens of clinical pneumonia in children. There are statistical differences in different age groups and seasons of hospitalized children's pneumonia in Suzhou. The mixed infection rate of bacteria and virus is high.
- Hospitalized children /
- Clinical pneumonia /
- Pathogenic distribution

HTML全文

图 1 儿童肺炎病原混合感染情况

Figure 1. Mixed infection of pneumonia in children

下载: 全尺寸图片幻灯片

表 1 研究对象与排除对象的基本特征分析[n (%)]

Table 1. Basic characteristics of research objects and exclusion objects [n (%)]

特征	纳入对象(n=4 765)	排除对象(n=1 062)	χ²/Z值	P值
性别			1.79	1.181
男	2 941(61.7)	632(59.5)
女	1 824(38.3)	430(40.5)
年龄(月)			-1.55	0.122
≤6	1197(25.1)	265(25.0)
7~	934(19.6)	172(16.2)
13~	2 549(53.5)	605(57.0)
> 60	85(1.8)	20(1.9)
季节			7.78	0.051
春季	1 287(27.0)	267(25.1)
夏季	995(20.9)	246(23.2)
秋季	1 075(22.6)	265(25.0)
冬季	1 408(29.5)	284(26.7)

下载: 导出CSV

表 2 儿童肺炎主要病原的月龄特点[n (%)]

Table 2. Age characteristics of main pathogens of pneumonia in children[n (%)]

	≤6月龄	7~月龄	13~月龄	> 60月龄	χ²值	P值
	(n=1 197)	(n=934)	(n=2 549)	(n=85)	χ²值	P值
细菌性病原					81.79	< 0.001
SP	149(12.4)	204(21.8)	597(23.4)	16(18.8)	62.51	< 0.001
H.i	197(16.5)	180(19.3)	355(13.9)	5(5.9)	21.84	< 0.001
SV	159(13.3)	142(15.2)	331(13.0)	10(11.8)	31.17	0.366
MC	63(5.3)	60(6.4)	166(6.5)	0(0.0)	7.95	0.047
SA	131(10.9)	21(2.2)	38(1.5)	3(3.5)	197.21	< 0.001
E.coli	18(1.5)	5(0.5)	3(0.1)	0(0.0)	-	< 0.001^a
PA	9(0.8)	5(0.5)	9(0.4)	0(0.0)	-	0.379^a
K.pn	9(0.8)	3(0.3)	1(0.0)	0(0.0)	-	0.001^a
病毒性病原	476(39.8)	447(47.9)	1 156(45.4)	22(25.9)	25.43	< 0.001
RSV	304(25.4)	178(19.1)	297(11.7)	1(1.2)	131.96	< 0.001
BoV	48(4.0)	139(14.9)	448(17.6)	12(14.1)	129.47	< 0.001
IFVA	39(3.3)	64(6.9)	191(7.5)	1(1.2)	29.56	< 0.001
IFVB	17(1.4)	29(3.1)	98(3.8)	4(4.7)	16.65	0.001
PIV	51(4.3)	57(6.1)	113(4.4)	1(1.2)	7.42	0.060
HMPV	29(2.4)	20(2.1)	45(1.8)	3(3.5)	2.84	0.418
ADV	5(0.4)	11(1.2)	61(2.4)	0(0.0)	23.02	< 0.001
注:^a对E.coli、PA、K.pn的月龄分布特点分析采用确切概率法。

下载: 导出CSV

表 3 儿童肺炎主要病原的季节特点[n (%)]

Table 3. Seasonal characteristics of main pathogens of pneumonia in children[n (%)]

	春季	夏季	秋季	冬季	χ²值	P值
	(n=1 287)	(n=995)	(n=1 075)	(n=1 408)	χ²值	P值
细菌性病原					43.67	< 0.001
SP	251(19.5)	167(16.8)	253(23.5)	295(21.0)	15.45	0.001
H.i	329(25.6)	118(11.9)	65(6.0)	225(16.0)	183.50	< 0.001
SV	135(10.5)	185(18.6)	221(20.6)	101(7.2)	126.42	< 0.001
MC	68(5.3)	55(5.5)	86(8.0)	80(5.7)	9.31	0.025
SA	58(4.5)	42(4.2)	41(3.8)	52(3.7)	1.38	0.710
E.coli	7(0.5)	6(0.6)	7(0.7)	6(0.4)	65.20	0.885
PA	3(0.2)	6(0.6)	11(1.0)	3(0.2)	10.63	0.014
K.pn	0(0.0)	6(0.6)	3(0.3)	4(0.3)	-	0.030^a
病毒性病原	505(39.2)	438(44.0)	484(45.0)	674(47.9)	20.83	< 0.001
RSV	147(11.4)	20(2.0)	236(22.0)	377(26.8)	162.58	< 0.001
细菌性病原	791(61.5)	561(56.4)	668(62.1)	716(50.9)	43.67	< 0.001
SP	251(19.5)	167(16.8)	253(23.5)	295(21.0)	15.45	0.001
H.i	329(25.6)	118(11.9)	65(6.0)	225(16.0)	183.50	< 0.001
SV	135(10.5)	185(18.6)	221(20.6)	101(7.2)	126.42	< 0.001
注:^a对K.pn的季节分布特点分析采用确切概率法。

下载: 导出CSV

表 4 儿童肺炎病原混合感染情况[n (%)]

Table 4. Mixed infection of pneumonia in children[n (%)]

	n	合并其他细菌感染	合并其他病毒感染	细菌-病毒混合感染
RSV	780	-	86(11.0)	451(57.8)
BoV	647	-	121(18.7)	412(63.7)
INF	443	-	91(20.5)	253(57.1)
PIV	222	-	26(11.7)	133(59.9)
ADV	77	-	6(7.8)	37(48.1)
HMPV	97	-	12(12.4)	40(41.2)
SP	851	167(19.6)	-	430(50.5)
H.i	737	182(24.7)	-	295(40.0)
SV	642	91(14.2)	-	324(50.5)
MC	289	111(38.4)	-	140(48.4)
SA	193	61(31.6)	-	66(34.2)

下载: 导出CSV

参考文献(16)

[1]	Cevey-Macherel M, Galetto-Lacour A, Gervaix A, et al. Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines[J]. Eur J Pediatr, 2009, 168(12): 1429-1436. DOI: 10.1007/s00431-009-0943-y.
[2]	中华医学会儿科学分会呼吸学组, 编辑委员会中华儿科杂志.儿童社区获得性肺炎管理指南(2013修订)(上)[J].中华儿科杂志, 2013, 51(10): 745-752. DOI: 10.3760/cma.j.issn.0578-1310.2013.10.006. Respiratory group, society of pediatrics, Chinese Society of Pediatrics, editorial board, Chinese Journal of Pediatrics. Guidelines for the management of community-acquired pneumonia in children(revised in 2013)(I)[J]. Chin J Pediatr, 2013, 51(10): 745-752. DOI: 10.3760/cma.j.issn.0578-1310.2013.10.006.
[3]	彭懿, 舒畅, 符州, 等.儿童社区获得性肺炎1613例病原学特点分析[J].中国当代儿科杂志, 2015(11): 1193-1199. DOI: 10.7499/j.issn.1008-8830.2015.11.009. Peng Y, Shu C, Fu Z, et al. Pathogen detection of 1 613 cases of hospitalized children with community acquired pneumonia[J]. Chin J Contemp Pediatr, 2015, 17(11): 1193-1199. DOI: 10.7499/j.issn.1008-8830.2015.11.009.
[4]	冯录召, 赖圣杰, 李夫, 等. 2009-2012年我国6省(市)5岁以下儿童住院肺炎病例的病毒病原学分析[J].中华流行病学杂志, 2014(6): 646-649. DOI: 10.3760/cma.j.issn.0254-6450.2014.06.007. Feng LZ, Lai SJ, Li F, et al. Viral etiologies of hospitalized pneumonia patients aged less than five years in six provinces, 2009-2012[J]. Chin J Epidemiol, 2014(6): 646-649. DOI: 10.3760/cma.j.issn.0254-6450.2014.06.007.
[5]	De-Schutter I, De-Wachter E, Crokaert F, et al. Microbiology of bronchoalveolar lavage fluid in children with acute nonresponding or recurrent community-acquired pneumonia: identification of nontypeable haemophilus influenzae as a major pathogen[J]. Clin Infect Dis, 2011, 52(12): 1437-1444. DOI: 10.1093/cid/cir235.
[6]	Ferone EA, Berezin EN, Durigon GS, et al. Clinical and epidemiological aspects related to the detection of adenovirus or respiratory syncytial virus in infants hospitalized for acute lower respiratory tract infection[J]. Jornal de Pediatria, 2014, 90(1): 42-49. DOI: 10.1016/j.jped.2013.05.005.
[7]	黄志英, 程宝金, 林红, 等. 80例住院患儿腺病毒呼吸道感染的流行病学特点和临床特征分析[J].病毒学报, 2014, 30(4): 408-411. DOI: 10.13242/j.cnki.bingduxuebao.002524. Huang ZY, Cheng BJ, Lin H, et al. Epidemiological and clinical characteristics of adenovirus respiratory tract infections in 80 hospitalized children[J]. Chin J Virol, 2014, 30(4): 408-411. DOI: 10.13242/j.cnki.bingduxuebao.002524.
[8]	冯英, 罗征秀, 符州, 等.重庆地区婴幼儿社区获得性肺炎病原学分析[J].儿科药学杂志, 2011, 17(5): 39-42. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=ekyx201105015 Feng Y, Luo ZX, Fu Z, et al. Etiology of children with community acquired pneumonia in chongqing area[J]. J Pediatr Pharm, 2011, 17(5): 39-42. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=ekyx201105015
[9]	罗蓉, 符州, 黄英, 等. 99例儿童腺病毒肺炎临床特征分析[J].重庆医学, 2014(30): 3997-3998, 4001. DOI: 10.3969/j.issn.1671-8348.2014.30.005. Luo R, Fu Z, Huang Y, et al. Clinical characteristic analysis of 99 adenovirus pneumonia cases in children[J]. Chongqing Med, 2014(30): 3997-3998, 4001. DOI: 10.3969/j.issn.1671-8348.2014.30.005.
[10]	陈倩, 施圣云, 胡正, 等.南京地区急性呼吸道感染儿童支原体、衣原体和常见呼吸道病毒病原学分析[J].中国当代儿科杂志, 2010, 12(6): 450-454. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgddekzz201006010 Chen Q, Shi SY, Hu Z, et al. Pathogenic analysis of mycoplasma, chlamydia and common respiratory viruses in children with acute respiratory infections in Nanjing[J]. Chin J Contemp Pediatr, 2010, 12(6): 450-454. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgddekzz201006010
[11]	Nascimento-Carvalho CM, Cardoso MA, Barral A, et al. Seasonal patterns of viral and bacterial infections among children hospitalized with community-acquired pneumonia in a tropical region[J]. Scand J Infect Dis, 2010, 42(11-12): 839-844. DOI: 10.3109/00365548.2010.498020.
[12]	张国英, 夏学红, 吕连峥. 503例儿童急性呼吸道感染常见病毒的检测结果分析[J].中国微生态学杂志, 2014, 26(10): 1206-1208. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgwstxzz201410027 Zhang GY, Xia XH, Lu LZ. Detection results of common viruses in 503 children with acute respiratory infections[J]. Chin J Microecol, 2014, 26(10): 1206-1208. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgwstxzz201410027
[13]	Prel JD, Puppe W, Grondahl B, et al. Are meteorological parameters associated with acute respiratory tract infections?[J]. Clin Infect Dis, 2009, 49(6): 861-868. DOI: 10.1086/605435.
[14]	Hament J, Aerts PC, Fleer A, et al. Enhanced adherence of streptococcus pneumoniae to human epithelial cells infected with respiratory syncytial virus[J]. Pediatr Res, 2004, 55(6): 972-978. DOI: 10.1203/01.PDR.0000127431.11750.D9.
[15]	Vasanthi A, Rodriguez CA, DeVincenzo JP, et al. Respiratory viruses augment the adhesion of bacterial pathogens to respiratory epithelium in a viral species-and cell type-dependent manner[J]. J Virol, 2006, 80. DOI: 10.1128/JVI.80.4.1629.
[16]	Papadopoulos NG, Moustaki M, Tsolia M, et al. Association of rhinovirus infection with increased disease severity in acute bronchiolitis[J]. Am J Respir Crit Care Med, 2002, 165(9): 1285-1289. DOI: 10.1164/rccm.200112-118BC.