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林秀华,杨燕珍▲,陈腾,李钦,戴雅静.鼻咽部菌群与重症RSV下呼吸道感染的相关性研究[J].中国医药科学,2023,(20):61-65        基金项目:
鼻咽部菌群与重症RSV下呼吸道感染的相关性研究
Research on the correlation between nasopharyngeal flora and severe RSV lower respiratory tract infection
  
DOI:
中文关键词:  呼吸道合胞病毒;鼻咽部;呼吸道定植菌;潮气肺功能
英文关键词:Respiratory syncytial virus; Nasopharyngeal region; Colonization bacteria of respiratory tract; Tidal lung function
作者单位
林秀华,杨燕珍▲,陈腾,李钦,戴雅静 福建医科大学附属漳州市医院儿科,福建漳州 363000 
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中文摘要:
      [摘要] 目的 研究鼻咽部菌群与重症呼吸道合胞病毒(RSV)下呼吸道感染病情特点的关系。 方法 回顾性分析2020年8月1日至2021年7月31日福建医科大学附属漳州市医院收治的重症RSV下呼吸道感染患儿238例,根据鼻咽部分泌物培养结果分为阴性组和阳性组,比较两组临床特点及潮气肺功能结果。 结果 238例重症RSV下呼吸道感染患儿,鼻咽部分泌物培养阳性组112例(47.06%),阴性组126例(52.94%)。前三种定植菌肺炎链球菌39例(34.82%),流感嗜血杆菌18例(16.07%),金黄色葡萄球菌14例(12.50%)。存在基础疾病患儿定植率明显高于无基础疾病患儿,差异有统计学意义(χ2=3.961,P=0.047)。阳性组与阴性组比较,ICU入住率高(χ2=7.892,P=0.005),达峰容积比(Z=-2.421,P=0.015)及达峰时间比(Z=-2.062,P=0.040)低,差异有统计学意义。而两组患儿发热比例(χ2=0.224,P=0.639)、喘息比例(χ2=0.563,P=0.455),差异无统计学意义。同阴性组比较,鼻咽部存在肺炎链球菌定植患儿发热率较高(86.84% vs. 61.90%,χ2=8.302,P=0.004),达峰容积比(Z=-3.292,P=0.001)及达峰时间比(Z=-3.123,P=0.002)降低更明显,差异有统计学意义(P < 0.05);存在流感嗜血杆菌患儿ICU入住率较高(44.44%∶15.87%,校正χ2=6.491,P=0.011);存在金黄色葡萄球菌患儿发热率较低(20.00% vs. 61.90%,χ2=9.632,P=0.002),差异有统计学意义。 结论重症RSV下呼吸道感染患儿鼻咽部定植率增加,特别是存在基础疾病患儿。流感嗜血杆菌定植增加ICU入住率,肺炎链球菌定植更易引起发热及加重小气道肺功能损害,而金黄色葡萄球菌定植可减少患儿发热概率。
英文摘要:
      [Abstract] Objective To study the correlation between nasopharyngeal flora and the characteristics of severe respiratory syncytial virus (RSV) lower respiratory tract infection. Methods A total of 238 cases affected children with severe RSV lower respiratory tract infection admitted to Zhangzhou Affiliated Hospital of Fujian Medical University from August 1, 2020 to July 31, 2021 were retrospectively analyzed. They were divided into the negative group (n=126) and the positive group (n=112) according to the results of nasopharyngeal secretion culture. And the clinical characteristics and tidal lung function results of the two groups were compared. Results In 238 affected children with severe RSV lower respiratory tract infection, there were 112 cases (47.06%) with positive nasopharyngeal secretion culture and 126 cases (52.94%) with negative nasopharyngeal secretion culture. There were 39 cases of Streptococcus pneumoniae (34.82%), 18 cases of Hemophilus influenzae (16.07%) and 14 cases of Staphylococcus aureus (12.50%). The colonization rate of children with basic diseases was significantly higher than that of children without basic diseases, with statistically significant difference (75.00%∶45.58%, χ2=3.961, P=0.047). Compared with the negative group, the ICU occupancy rate in the positive group was higher (31.25%∶15.87%, χ2=7.892, P =0.005), the volume ratio to peak (Z=-2.421, P=0.015) and the time ratio to peak (Z=-2.062, P=0.040) were low, with statistically significant differences. However, there were not statistically significant differences in the proportions of children’s fever (χ2=0.224, P=0.639) and wheezing (χ2=0.563, P=0.455) between the two groups of affected children. Compared with the negative group, affected children with Streptococcus pneumoniae colonization in the nasopharynx had a higher fever rate (86.84% vs. 61.90%, χ2=8.302, P=0.004), and a more significant decrease in peak volume ratio (Z=-3.292, P=0.001) and peak time ratio (Z=-3.123, P=0.002), with statistically significant differences (P < 0.05). The ICU occupancy rate of children with Hemophilus influenzae was higher (44.44%∶15.87%, adjusted χ2=6.491, P=0.011), and the fever rate of children with Staphylococcus aureus was lower (20.00% vs. 61.90%, χ2=9.632, P=0.002) with statistica-lly significant differences. Conclusion The rate of nasopharyngeal colonization in children with severe RSV lower respiratory tract infection increases, especially in children with basic diseases. The Hemophilus influenzae colonization increases ICU occupancy rate, and Streptococcus pneumoniae colonization is more likely to cause fever and aggravate small airway lung function damage, while Staphylococcus aureus colonization can reduce the probability of fever in the affected children.
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