佛山市学龄前儿童肺炎链球菌的传播模式及影响因素

余海峰; 邓文君; 李平原; 张景锋; 周俊立; 姚振江; 叶小华

doi:10.16462/j.cnki.zhjbkz.2023.02.010

佛山市学龄前儿童肺炎链球菌的传播模式及影响因素

doi: 10.16462/j.cnki.zhjbkz.2023.02.010

1.
528300 佛山，广州中医药大学顺德医院附属勒流医院体检科
2.
510310 广州，广东药科大学公共卫生学院流行病与卫生统计学系

基金项目:

国家自然科学基金 81973069

广东省基础与应用基础研究基金 2019A1515010915

详细信息

通讯作者:
叶小华，E-mail：smalltomato@163.com

中图分类号: R179;R378.1+2
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出版历程
- 收稿日期: 2022-07-10
- 修回日期: 2022-10-06
- 网络出版日期: 2023-02-20
- 刊出日期: 2023-02-10

Transmission modes and influencing factors of Streptococcus pneumoniae among preschool children in Foshan

1.
Medical Examination Department, Leliu Hospital Affiliated to Shunde Hospital, Guangzhou University of Traditional Chinese Medicine, Foshan 528300, China
2.
Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China

Funds:

National Natural Science Foundation of China 81973069

Guangdong Basic and Applied Basic Research Foundation 2019A1515010915

More Information

Corresponding author: YE Xiao-hua, E-mail: smalltomato@163.com

摘要

摘要: 目的掌握学龄前儿童肺炎链球菌的传播模式及其影响因素，为揭示传播模式和控制传播提供重要的科学依据。方法采用分层整群抽样法，抽取佛山市顺德区7所幼儿园2 031名健康儿童，进行鼻拭子采样并分离鉴定肺炎链球菌。儿童肺炎链球菌携带的聚集性分析采用随机效应模型，运用分子型别的同源性分析揭示传播模式，肺炎链球菌携带的影响因素采用χ²检验与随机效应logistic回归分析模型相结合方法。结果儿童鼻腔肺炎链球菌携带率为21.8%。随机效应模型分析提示，儿童肺炎链球菌携带存在班级聚集性(Z=4.34, P < 0.001)；7所幼儿园菌株班级内同源率分别为60.9%、79.2%、76.0%、80.0%、82.8%、75.9%和33.3%；班级间同源率分别为90.6%、91.7%、88.0%、82.9%、63.8%、93.1%和76.2%。影响因素分析表明，非佛山市户籍(OR=1.36, 95% CI: 1.04~1.79, P=0.027)、农村地区(OR=1.60, 95% CI: 1.09~2.35, P=0.017)、鼻腔携带卡他莫拉杆菌(OR=1.91, 95% CI: 1.49~2.45, P < 0.001)是肺炎链球菌携带的危险因素；年级升高(OR=0.66, 95% CI: 0.52~0.83, P < 0.001)、鼻腔携带金黄色葡萄球菌(OR=0.41, 95% CI: 0.31~0.55, P < 0.001)是肺炎链球菌携带的保护因素。结论儿童肺炎链球菌存在较高的班级内和班级间传播风险，年级、户籍、地区以及鼻腔其他细菌携带情况是学龄前儿童肺炎链球菌携带的重要影响因素。
- 肺炎链球菌 /
- 聚集性 /
- 影响因素 /
- 儿童
Abstract: Objective To urderstand the transmission mode and influencing factors of Streptococcus pneumoniae (S. pneumoniae) in preschool children, and to provide an important scientific basis for revealing the transmission pattern and controlling the transmission. Methods Stratified cluster sampling method was used to select 2 031 healthy children from seven kindergartens in Shunde District, Foshan City. Nasal swabs were taken and tested for S. pneumoniae. The random-effect model was used to explore the clustering of S. pneumoniae carriage in children, and homology analysis of molecular types was used to reveal the transmission mode. Both χ² test and random-effect logistic regression were used to analyze the effects of multiple influencing factors. Results The nasal carriage rate of S. pneumoniae in children was 21.8%. Random-effect model indicated that there was a class-level clustering effect of S. pneumoniae carriage in children (Z=4.34, P < 0.001). The within-class homology rates of strains in seven kindergartens were 60.9%, 79.2%, 76.0%, 80.0%, 82.8%, 75.9% and 33.3%, respectively. The between-class homology rates were 90.6%, 91.7%, 88.0%, 82.9%, 63.8%, 93.1% and 76.2%, respectively. The analysis of influencing factors showed that non-household registration (OR=1.36, 95% CI: 1.04-1.79, P=0.027), rural area (OR=1.60, 95% CI: 1.09-2.35, P=0.017) and nasal carrying Moraxella catarrhalis (OR=1.91, 95% CI: 1.49-2.45, P < 0.001) were risk factors for S. pneumoniae carriage, while grade (OR=0.66, 95% CI: 0.52-0.83, P < 0.001) and nasal Staphylococcus aureus carriage (OR=0.41, 95% CI: 0.31-0.55, P < 0.001) were protective factors. Conclusions There is a high risk of S. pneumoniae transmission among children within and between classes. Grade, household registration, area and nasal carriage of other bacteria are important influencing factors for S. pneumoniae carriage in preschool children.
- Streptococcus pneumoniae /
- Clustering /
- Influencing factors /
- Children

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图 1 幼儿园肺炎链球菌ST型别同源分布情况

注：外圈节点表示班级，圈内连线表示同源ST型，连线宽度表示同源数值。(A)表示幼儿园A; (B)表示幼儿园B; (C)表示幼儿园C; (D)表示幼儿园D; (E)表示幼儿园E; (F)表示幼儿园F; (G)表示幼儿园G。

Figure 1. Homology distribution of Streptococcus pneumoniae in kindergarten

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表 1 儿童肺炎链球菌携带的聚集性分析

Table 1. Clustering analysis of Streptococcus pneumoniae carriage in children

分层变量	固定效应				随机效应
分层变量	β₀值	s_x值	Z值	P值	σ_u0²值	s_x值	Z值	P值	ICC值(%)
总体	-1.40	0.12	-12.05	< 0.001	0.74	0.17	4.34	< 0.001	18.4
性别
男	-1.41	0.13	-10.70	< 0.001	0.76	0.23	3.37	< 0.001	18.8
女	-1.48	0.15	-9.90	< 0.001	0.92	0.28	3.24	0.001	21.9
年级
小班	-0.93	0.20	-4.64	< 0.001	0.92	0.33	2.84	0.004	21.9
中班	-1.58	0.19	-8.34	< 0.001	0.51	0.24	2.15	0.031	13.5
大班	-1.79	0.11	-16.39	< 0.001	< 0.01	< 0.01	< 0.01	1.000	< 0.1
户籍
佛山市	-1.61	0.15	-10.75	< 0.001	0.98	0.28	3.50	< 0.001	23.0
其他	-1.18	0.12	-9.60	< 0.001	0.53	0.19	2.81	0.005	13.9
地区
城镇	-1.67	0.14	-11.68	< 0.001	0.45	0.17	2.56	0.010	12.0
农村	-1.13	0.17	-6.67	< 0.001	0.84	0.26	3.23	0.001	20.3

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表 2 儿童肺炎链球菌携带的单因素分析结果[n(%)]

Table 2. Results of univariate analysis of Streptococcus pneumoniae carriage in children [n(%)]

影响因素	携带人数	χ²值	P值	影响因素	携带人数	χ²值	P值
年级		62.13 ^a	< 0.001	近两周抗生素使用史		2.04	0.361
小班(n=690)	220(31.9)			无(n=1 521)	321(21.1)
中班(n=657)	125(19.0)			有(n=319)	74(23.2)
大班(n=684)	98(14.3)			不详(n=191)	48(25.1)
性别		0.02	0.875	近三月呼吸道感染史		4.77	0.029
男(n=1 112)	244(21.9)			无(n=783)	151(19.3)
女(n=919)	199(21.7)			有(n=1 248)	292(23.4)
户籍		7.06	0.008	肺炎球菌疫苗接种史		3.02	0.221
佛山市(n=1 144)	225(19.7)			无(n=801)	162(20.2)
其他(n=887)	218(24.6)			有(n=637)	153(24.0)
地区		26.53	< 0.001	不详(n=593)	128(21.6)
城镇(n=1 054)	182(17.3)			总居住面积(m²)		9.80 ^a	0.002
农村(n=977)	261(26.7)			≤50(n=282)	81(28.7)
同住儿童		3.22	0.073	>50~100(n=940)	206(21.9)
无(n=140)	39(27.9)			>100(n=809)	156(19.3)
有(n=1 891)	404(21.4)			单独睡觉频率		7.26^a	0.007
鼻腔携带金葡菌		64.04	< 0.001	从未(n=1 775)	402(22.7)
否(n=1 346)	364(27.0)			偶尔(n=136)	26(19.1)
是(n=685)	79(11.5)			经常(n=120)	15(12.5)
鼻腔携带卡他菌		56.24	< 0.001	参加托管班		3.67	0.055
否(n=966)	141(14.6)			无(n=1 720)	388(22.6)
是(n=1 065)	302(28.4)			有(n=311)	55(17.7)
注：^a表示采用趋势χ²检验。

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表 3 儿童肺炎链球菌携带影响因素的随机效应logistic回归分析模型分析

Table 3. Random-effect logistic model for influencing factors of Streptococcus pneumoniae carriage in children

影响因素	β值	s_x值	Z值	OR(95% CI)值	P值
固定部分
截距	-1.87	0.76	-2.46	0.15(0.03~0.69)	0.014
年级(小班=1，中班=2，大班=3)	-0.42	0.12	-3.55	0.66(0.52~0.83)	< 0.001
户籍(其他=1，佛山市=0)	0.31	0.14	2.21	1.36(1.04~1.79)	0.027
地区(农村=1，城镇=0)	0.47	0.20	2.39	1.60(1.09~2.35)	0.017
鼻腔携带卡他菌(是=1，否=0)	0.65	0.13	5.08	1.91(1.49~2.45)	< 0.001
鼻腔携带金葡菌(是=1，否=0)	-0.89	0.15	-6.07	0.41(0.31~0.55)	< 0.001
总居住面积(≤50 m²=1，>50~100 m²=2，>100 m²=3)	-0.10	0.10	-0.95	0.91(0.75~1.11)	0.340
单独睡觉频率(经常=1，偶尔=2，从未=3)	0.16	0.13	1.22	1.17(0.91~1.52)	0.224
同住儿童(是=1，否=0)	-0.22	0.22	-1.01	0.80(0.52~1.23)	0.315
近三个月呼吸道感染史(是=1，否=0)	-0.11	0.13	-0.85	0.90(0.70~1.15)	0.395
参加托管班(有=1，无=0)	0.06	0.18	0.32	1.06(0.75~1.50)	0.751
随机部分
水平2方差	0.41	0.12	3.48		< 0.001
水平1尺度参数	1.00

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