文章摘要
伊丽萍,薛建,任少龙,沈思,李赵进,钱晨,林婉靖,田健美,张涛,邵雪君,赵根明.儿童肺炎支原体感染的临床特征及混合感染相关因素研究[J].中华流行病学杂志,2022,43(9):1448-1454
儿童肺炎支原体感染的临床特征及混合感染相关因素研究
Clinical characteristics of Mycoplasma pneumoniae infection and factors associated with co-infections in children
收稿日期:2022-03-21  出版日期:2022-09-09
DOI:10.3760/cma.j.cn112338-20220321-00210
中文关键词: 肺炎支原体;儿童;社区获得性肺炎;混合感染
英文关键词: Mycoplasma pneumoniae;Children;Community acquired pneumonia;Co-infection
基金项目:上海市市级科技重大专项(ZD2021CY001);国家科技基础资源调查专项(2019FY101204);上海市公共卫生体系建设三年行动计划(2020-2022)重点学科建设(GWV-10.1-XK16)
作者单位E-mail
伊丽萍 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, 上海 200032  
薛建 苏州大学附属儿童医院, 苏州 215003  
任少龙 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, 上海 200032  
沈思 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, 上海 200032  
李赵进 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, 上海 200032  
钱晨 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, 上海 200032  
林婉靖 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, 上海 200032  
田健美 苏州大学附属儿童医院, 苏州 215003  
张涛 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, 上海 200032  
邵雪君 苏州大学附属儿童医院, 苏州 215003 xjshao@suda.edu.cn 
赵根明 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, 上海 200032
上海市重大传染病和生物安全研究院, 上海 200032 
gmzhao@shmu.edu.cn 
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中文摘要:
      目的 了解儿童肺炎支原体(Mp)感染的临床特征,分析Mp与其他病原体混合感染的相关因素,为完善儿童社区获得性肺炎(CAP)防治提供证据支持。方法 基于在苏州大学附属儿童医院(SCH)开展的急性呼吸道感染病例监测,筛选2018-2021年在SCH住院的<16岁CAP病例,采用统一的调查表收集研究对象基本情况、基础疾病史、临床表现等信息,通过医院检验信息系统查询研究对象的病原检测结果,比较Mp、细菌、病毒等病原体感染者的临床特征,比较Mp混合其他病原感染对病情严重性的影响,采用logistic回归模型分析Mp混合其他病原感染的相关因素。结果 共收集8 274名CAP住院病例,其中Mp阳性2 184例(26.4%);Mp检出率女童高于男童(P<0.001),随月龄增加而升高(P<0.001),夏秋季高于冬春季(P<0.001)。喘息、气促、喘鸣音及肺部呈片状阴影的发生率,以及发热和住院天数等指标在Mp、细菌和病毒感染病例中的差异均有统计学意义(均P<0.05)。<60月龄Mp混合感染病例出现喘息症状及痰鸣音和喘鸣音的比例高于单纯感染病例,≥60月龄混合感染病例较Mp单纯感染更易出现气促症状(均P<0.05)。多因素logistic回归模型分析显示,男童(aOR=1.38,95%CI:1.15~1.67)、<6月龄(aOR=3.30,95%CI:2.25~4.89)、6~月龄(aOR=3.44,95%CI:2.63~4.51)、24~月龄(aOR=2.50,95%CI:1.90~3.30)、48~71月龄(aOR=1.77,95%CI:1.32~2.37)和3个月内呼吸系统感染史(aOR=1.28,95%CI:1.06~1.55)为Mp混合其他病原感染的相关因素。结论 Mp是导致儿童CAP住院的主要病原体,单纯Mp感染病例较细菌、病毒感染病例发热天数更长;Mp常与细菌和病毒混合感染,男童、<72月龄和3个月内呼吸系统感染史是Mp混合感染的相关因素。
英文摘要:
      Objective To describe the clinical characteristics of Mycoplasma pneumoniae infection and analyze the factors associated with co-infections with other pathogens in children,and provide evidence for improvement of community acquired pneumonia (CAP) prevention and control in children.Methods Based on the surveillance of hospitalized acute respiratory infections cases conducted in Soochow University Affiliated Children's Hospital (SCH),the CAP cases aged<16 years hospitalized in SCH between 2018 and 2021 were screened.The pathogenic test results of the cases were obtained through the laboratory information system,and their basic information,underlying conditions,and clinical characteristics were collected using a standardized questionnaire.The differences in clinical characteristics between M.pneumoniae infection and bacterial or viral infection and the effect of the co-infection of M.pneumoniae with other pathogens on clinical severity in the cases were analyzed;logistic regression was used to analyze the factors associated with the co-infections with other pathogens.Results A total of 8 274 hospitalized CAP cases met the inclusion criteria.Among them,2 184 were positive for M.pneumoniae(26.4%).The M.pneumoniae positivity rate increased with age (P<0.001),and it was higher in girls (P<0.001) and in summer and autumn (P<0.001).There were statistically significant differences in the incidence of wheezing,shortness of breath,wheezing sounds and visible lamellar faint shadow on chest radiographs,as well as fever and hospitalization days among M.pneumoniae,bacterial,and viral infection cases (all P<0.05).In the cases aged<60 months years,co-infection cases had higher rates of wheezing,gurgling with sputum and stridor;and in the cases aged ≥ 60 months,co-infection cases had a higher rate of shortness of breath (all P<0.05).Multifactorial logistic regression analysis showed that being boys (aOR=1.38,95%CI:1.15-1.67),being aged<6 months (aOR=3.30,95%CI:2.25-4.89),6-23 months (aOR=3.44,95%CI:2.63-4.51),24-47 months (aOR=2.50,95%CI:1.90-3.30) and 48-71 months (aOR=1.77,95%CI:1.32-2.37),and history of respiratory infection within 3 months (aOR=1.28,95%CI:1.06-1.55) were factors associated with co-infections of M.pneumoniae with other pathogens.Conclusions M.pneumoniae was the leading pathogen in children hospitalized due to CAP.M.pneumoniae infections could cause fever for longer days compared with bacterial or viral infections;M.pneumoniae was often co-detected with virus or bacteria.Being boys,being aged<72 months and history of respiratory infection within 3 months were associated factors for co-infections.
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