儿童甲型和乙型流感病毒肺炎临床特征和混合感染比较

华军; 杜晓晨; 李莺; 谢敏慧; 张学兰; 丁云芳; 郝创利; 季伟

doi:10.7499/j.issn.1008-8830.2013.11.016

PDF(1419 KB)

中国当代儿科杂志 ›› 2013, Vol. 15 ›› Issue (11) : 990-994. DOI: 10.7499/j.issn.1008-8830.2013.11.016

论著·临床研究

儿童甲型和乙型流感病毒肺炎临床特征和混合感染比较

华军，杜晓晨，李莺，谢敏慧，张学兰，丁云芳，郝创利，季伟

作者信息 +

Comparison of clinical features and co-infection between pneumonia caused by influenza virus A and pneumonia caused by influenza virus B among children

HUA Jun, DU Xiao-Chen, LI Ying, XIE Min-Hui, ZHANG Xue-Lan, DING Yun-Fang, HAO Chuang-Li, JI Wei

Author information +

文章历史 +

摘要

目的：比较儿童甲型和乙型流感病毒（IV）肺炎的临床表现和混合感染情况。方法：选取165例IV肺炎患儿为研究对象，根据IV亚型分为甲型流感病毒肺炎（IVA，71例）和乙型流感病毒肺炎（IVB，94例）两组；再根据是否合并其他病原感染分为单纯感染IVA组（14例）、IVA混合感染组（57例）、单纯感染IVB组（27例）和IVB混合感染组（67例），分析儿童IV肺炎的混合感染率及病原菌分布情况。结果：IVB组的平均发病年龄和平均发热天数均显著大于IVA组（均P<0.05）。IV肺炎患儿的混合感染率为75.2%，细菌混合感染率为44.2%，肺炎支原体混合感染率为21.8%。IV肺炎合并其他病毒混合感染率为45.5%，其中89%为呼吸道合胞病毒（RSV）感染；IVA组RSV混合感染率显著高于IVB组（P<0.05）。除白细胞计数和肌酐水平外，年龄、住院天数、发热天数、中性粒细胞百分比、前白蛋白、C反应蛋白、谷丙转氨酶、肌酸激酶同功酶等临床指标在单纯IV肺炎组和IV混合感染组差异均无统计学意义。结论：IVB肺炎患儿发热时间更长且发病年龄更大；IV肺炎混合感染率高，呈细菌、病毒和肺炎支原体多病原混合感染；IVA更易合并RSV混合感染；临床指标大多不易区别是否存在混合感染。

Abstract

OBJECTIVE: To compare the clinical features and co-infection between pneumonia caused by influenza virus A (IVA) and pneumonia caused by influenza virus B (IVB) among children. METHODS: A total of 165 children with pneumonia caused by influenza virus (IV) were included in the study. These subjects were divided into IVA(n=71) and IVB pneumonia groups (n=94) according to the subtypes of IV. The IVA pneumonia group was further divided into simple infection (n=14) and co-infection subgroups (n=57), and the IVB pneumonia group was also further divided into simple infection (n=27) and co-infection subgroups (n=67). Co-infection rate and pathogen spectrum were analysed in children with IV pneumonia. RESULTS: The IVB pneumonia group had significantly increased mean age of onset and significantly prolonged mean duration of fever compared with the IVA pneumonia group (P<0.05). Co-infection rate among children with IV pneumonia was 75.2%, who were co-infected with bacteria (44.2%), Mycoplasma pneumoniae (MP, 21.8%) and other viruses (45.5%). Respiratory syncytial virus (RSV) was most common in children co-infected viruses (89% ). The rate of co-infection with RSV was significantly higher in the IVA pneumonia group than in the IVB pneumonia group. There were no significant differences in age, length of hospital stay, duration of fever, percentage of neutrophils, prealbumin, C-reactive protein, alanine aminotransferase, and creatine kinase-MB between the simple infection and co-infection subgroups of each group. CONCLUSIONS: Children with IVB pneumonia have prolonged duration of fever and increased age of onset compared with those with IVA pneumonia. Co-infection rate is high among children with IV pneumonia, who may be co-infected with bacteria, viruses and MP. Co-infection with RSV is more common in children with IVA pneumonia. It is difficult to identify the presense of co-infection using clinical indices.

导出引用

华军，杜晓晨，李莺，谢敏慧，张学兰，丁云芳，郝创利，季伟. 儿童甲型和乙型流感病毒肺炎临床特征和混合感染比较[J]. 中国当代儿科杂志. 2013, 15(11): 990-994 https://doi.org/10.7499/j.issn.1008-8830.2013.11.016

HUA Jun, DU Xiao-Chen, LI Ying, XIE Min-Hui, ZHANG Xue-Lan, DING Yun-Fang, HAO Chuang-Li, JI Wei. Comparison of clinical features and co-infection between pneumonia caused by influenza virus A and pneumonia caused by influenza virus B among children[J]. Chinese Journal of Contemporary Pediatrics. 2013, 15(11): 990-994 https://doi.org/10.7499/j.issn.1008-8830.2013.11.016

参考文献

[1] 钟南山, 王辰, 王广发, 邓国华, 申昆玲, 刘又宁, 等. 流行性感冒诊断与治疗指南（2011版）[J].社区医学杂志, 2011, 9(5): 66-74.

[2] Morens DM, Taubenberger JK, Fauci AS. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness[J]. J Infect Dis, 2008, 198(7): 962-970.

[3] 张学兰, 季正华, 丁云芳, 朱宏, 季伟, 严永东, 等. 2005年苏州地区呼吸道感染儿童中流感病毒的检测与分析[J]. 临床儿科杂志, 2007, 2005(7): 551-553.

[4] 中国国家流感中心.中国流感流行情况概要[N/OL]. 流感周报, 2012, 第6周. http://www.cnic.org.cn/chn/down/showdown.php?downid=690.

[5] 中华医学会儿科学分会呼吸学组.儿童社区获得性肺炎管理指南(试行)(上)[J]. 中华儿科杂志, 2007, 45(2): 83-90.

[6] Clark NM, Lynch JP 3rd. Influenza: epidemiology, clinical features, therapy, and prevention[J]. Semin Respir Crit Care Med, 2011, 32(4): 373-392.

[7] 张学兰, 季正华, 季伟, 丁云芳, 朱宏, 严永东. 苏州地区呼吸道感染儿童中呼吸道７种病毒的流行病学监测[J]. 苏州大学学报（医学版）, 2008, 28(4): 570-572.

[8] 华军, 杜晓晨, 谢敏慧, 张学兰, 丁云芳, 季伟. 流感病毒B监测与儿童单纯B型流感病毒肺炎临床特征分析[J]. 中国当代儿科杂志, 2012, 14(11): 830-833．

[9] 沙莉, 朱汝南, 曹玲, 袁艺, 李颖, 曲东, 等. 北京季节性甲型流感与2009甲型H1N1流感住院患儿的临床比较[J]. 中华儿科杂志, 2011, 49(7): 539-544.

[10] 谢建屏, 赖桂香, 何翠娟, 刘晓敏, 万根平, 朱冰, 等. 1998~2002年广州地区儿童B型流感病毒亚型监测[J]. 现代临床医学生物工程学杂志, 2003, 9(5): 420-421.

[11] 张烨, 温乐英, 赵翔, 李梓, 郭俊峰, 徐翠玲, 等. 2004-2005年中国B型流感病毒抗原性及基因特性研究[J]. 中华实验和临床病毒学杂志, 2006, 20(2): 11-13.

[12] Esposito S, Molteni CG, Daleno C, Valzano A, Fossali E, Da Dalt L, et al. Clinical and socioeconomic impact of different types and subtypes of seasonal influenza viruses in children during influenza seasons 2007/2008 and 2008/2009[J]. BMC Infect Dis, 2011, 11: 271.

[13] 朱秋丽, 张学兰, 张涛, 赵根明, 丁云芳. 2005年至2009年苏州地区儿童流行性感冒住院病例临床特征的回顾性分析[J]. 中华传染病杂志, 2010, 28(10): 597-601.

[14] Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011[J]. Thorax, 2011, 66(Suppl 2): ii1-23.

[15] 陈蓉, 赵根明, 林玉尊, 郝传利, 丁云芳. 儿童细菌性下呼吸道感染两种采样方法的结果分析[J]. 中国当代儿科杂志, 2010, 5(12): 393-395.

[16] Levine OS, Liu G, Garman RL, Dowell SF, Yu S, Yang YH. Haemophilus Influenzae type b and Streptococcus pneumoniae as causes of pneumonia among children in Beijing, China[J]. Emerg Infect Dis, 2000, 6(2): 165-170.

[17] Uehara S, Sunakawa K, Eguchi H, Ouchi K, Okada K, Kurosaki T, et al. Japanese guidelines for the management of respiratory infectious fiseases in children 2007 with focus on pneumonia[J]. Pediatr Int, 2011, 53(2): 264-276.