儿童肺炎支原体肺炎病原检测的多中心临床研究

doi:10.3760/cma.j.cn112140-20240117-00054

科研成果详情

题名	儿童肺炎支原体肺炎病原检测的多中心临床研究
其他题名	A multicenter study on respiratory pathogen detection with Mycoplasma pneumoniae pneumonia in children
作者	董晓艳 1; 邹映雪 2; 吕芳芳3; 杨文豪 4; 张海邻3; 牛艳华 1; 王豪杰 1; 郭润 2; 王旭 2; 黎历 2; 林子豪3; 罗丽 5; 卢丹莉 4; 陆权 1; 刘瀚旻 4; 陈莉娜 4
发表日期	2024-04-02
发表期刊	中华儿科杂志影响因子和分区
语种	中文
原始文献类型	Periodical
关键词	支原体，肺炎儿童肺炎病原共检出率
其他关键词	Mycoplasma pneumoniae ; Child ; Pneumonia ; Pathogen co-detection rate
摘要	目的:分析儿童肺炎支原体肺炎（MPP）呼吸道病原检测状况及临床特征。方法:前瞻性多中心研究，收集2023年11月15日至12月20日4家医院298例诊断为MPP患儿的一般病例资料、实验室检查及呼吸道多重核酸检测结果，分析不同地区MPP患儿呼吸道病原检测情况及临床特征。将患儿按照病情程度分为重症组和轻症组，其中重症组中根据呼吸道多重核酸检测是否检出除肺炎支原体（MP）以外的病原体分为单纯MP组和多病原共检出组，分析呼吸道病原共检出状况对病情严重度的影响。组间比较采用Mann-Whitney非参数秩和检验、 χ2检验。结果:298例患儿中男136例、女162例。重症组204例，起病年龄7.0（6.0，8.0）岁，轻症组94例，起病年龄6.5（4.0，7.8）岁。重症组外周血C反应蛋白、D二聚体、血清乳酸脱氢酶（LDH）水平均高于轻症组［10.0（5.0，18.0）比5.0（5.0，7.5）mg/L、0.6（0.4，1.1）比0.5（0.3，0.6）mg/L、337（286，431）比314（271，393）U/L， Z=2.02、2.50、3.05，均 P<0.05］，住院时间长于轻症组［6.0（6.0，7.0）比5.0（4.0，6.0）d， Z=4.37， P<0.05］，起病至入院时间则短于轻症组［6.0（5.0，9.5）比9.0（7.0，13.0）d， Z=2.23， P=0.026］。所有患儿均完成了呼吸道病原体多重PCR检测，共有142例（47.7%）MPP患儿检出了21种病原，其中腺病毒25例（8.4%）、人类冠状病毒23例（7.7%）、鼻病毒21例（7.0%）、肺炎链球菌21例（7.0%）、甲型流感病毒18例（6.0%）。天津、上海、温州、成都地区检出率最高的病原分别为金黄色葡萄球菌［10.7%（8/75）］、腺病毒［13.0%（10/77）］、腺病毒［15.3%（9/59）］、鼻病毒和流感嗜血杆菌［均为11.5%（10/87）］。重症组中2种及以上病原体的共检出率高于轻症组［52.9%（108/204）比36.2%（34/94）， χ2=10.62， P=0.005］。多病原共检出组89例、单纯MP组73例。多病原共检出组LDH、D二聚体、中性粒细胞计数均高于单纯MP组［348（284，422）比307（270，358）U/L、0.8（0.5，1.5）比0.6（0.4，1.0）mg/L、4.99（3.66，6.89）×10 9比4.06（2.91，5.65）×10 9/L， Z=5.17、4.99、6.11，均 P<0.05］。结论:重症MPP患儿多病原共检出率、LDH、D二聚体较高，存在合并感染的重症MPP患儿机体应激反应更强。
其他摘要	Objective:To analyze the status of respiratory pathogen detection and the clinical features in children with Mycoplasma pneumoniae pneumonia (MPP). Methods:A prospective, multicenter study was conducted to collect clinical data, including medical history, laboratory examinations and multiplex PCR tests of children diagnosed with MPP from 4 hospitals in China between November 15 th and December 20 th, 2023. The multiplex PCR results and clinical characteristics of MPP children in different regions were analyzed. The children were divided into severe and mild groups according to the severity of the disease. Patients in the severe group were further divided into Mycoplasma pneumoniae (MP) alone and Multi-pathogen co-detection groups based on whether other pathogens were detected besides MP, to analyze the influence of respiratory pathogen co-detection rate on the severity of the disease. Mann-Whitney rank sum test and Chi-square test were used to compare data between independent groups. Results:A total of 298 children, 136 males and 162 females, were enrolled in this study, including 204 children in the severe group with an onset age of 7.0 (6.0, 8.0) years, and 94 children in the mild group with an onset age of 6.5 (4.0, 7.8) years. The level of C-reactive protein, D-dimer, lactic dehydrogenase (LDH) were significantly higher (10.0 (5.0, 18.0) vs. 5.0 (5.0, 7.5) mg/L, 0.6 (0.4, 1.1) vs. 0.5 (0.3, 0.6) mg/L, 337 (286, 431) vs. 314 (271, 393) U/L, Z=2.02, 2.50, 3.05, all P<0.05), and the length of hospitalization was significantly longer in the severe group compared with those in mild group (6.0 (6.0, 7.0) vs. 5.0 (4.0, 6.0) d, Z=4.37, P<0.05). The time from onset to admission in severe MPP children was significantly shorter than that in mild MPP children (6.0 (5.0, 9.5) vs. 9.0 (7.0, 13.0) d, Z=2.23, P=0.026). All patients completed the multiplex PCR test, with 142 cases (47.7%) MPP children detected with 21 pathogens including adenovirus 25 cases (8.4%), human coronavirus 23 cases (7.7%), rhinovirus 21 cases (7.0%), Streptococcus pneumoniae 21 cases (7.0%), influenza A virus 18 cases (6.0%). The pathogens with the highest detection rates in Tianjin, Shanghai, Wenzhou and Chengdu were Staphylococcus aureus at 10.7% (8/75), adenovirus at 13.0% (10/77), adenovirus at 15.3% (9/59), and both rhinovirus and Haemophilus influenzae at 11.5% (10/87) each. The multi-pathogen co-detection rate in severe MPP children was significantly higher than that in mild MPP group (52.9% (108/204) vs. 36.2% (34/94), χ2=10.62, P=0.005). Among severe MPP children, there are 89 cases in the multi-pathogen co-detection group and 73 cases in the simple MPP group. The levels of LDH, D-dimer and neutrophil counts in the multi-pathogen co-detection group were significantly higher than those in the simple MPP group (348 (284, 422) vs. 307 (270, 358) U/L, 0.8 (0.5, 1.5) vs. 0.6 (0.4, 1.0) mg/L, 4.99 (3.66, 6.89)×10 9vs. 4.06 (2.91, 5.65)×10 9/L, Z=5.17, 4.99, 6.11, all P<0.05). Conclusions:The co-detection rate of respiratory pathogens, LDH and D-dimer in children with severe MPP were higher than those with mild MPP. Among severe MPP children the stress response of children in co-detection group was more serious than that of children with simple MPP.
资助项目	四川省重大科技专项(2022ZDZX0021);天津市卫健委重点学科专项(TJWJ2022XK038)。
ISSN	0578-1310
卷号	62 期号:4 页码:310-316
DOI	10.3760/cma.j.cn112140-20240117-00054
页数	7
收录类别	万方 ; 维普 ; CSCD ; ISTIC ; 北大核心
URL	查看原文
引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/211335
专题	第二临床医学院、附属第二医院、育英儿童医院附属第二医院附属第二医院_儿童呼吸科
作者单位	1.上海市儿童医院　上海交通大学医学院附属儿童医院呼吸科，上海　200062; 2.天津市儿童医院(天津大学儿童医院)马场院区呼吸科，天津　300074; 3.温州医科大学附属第二医院育英儿童医院儿童呼吸科，温州　325027; 4.四川大学华西第二医院小儿呼吸免疫科，成都　610041; 5.雅安市人民医院呼吸儿科，雅安　625000
推荐引用方式 GB/T 7714	董晓艳,邹映雪,吕芳芳,等. 儿童肺炎支原体肺炎病原检测的多中心临床研究[J]. 中华儿科杂志,2024,62(4):310-316.
APA	董晓艳., 邹映雪., 吕芳芳., 杨文豪., 张海邻., ... & 陈莉娜. (2024). 儿童肺炎支原体肺炎病原检测的多中心临床研究. 中华儿科杂志, 62(4), 310-316.
MLA	董晓艳,et al."儿童肺炎支原体肺炎病原检测的多中心临床研究".中华儿科杂志 62.4(2024):310-316.