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冬春季小儿下呼吸道感染病原体及炎症标志物分析

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冬春季小儿下呼吸道感染病原体及炎症标志物分析

河北医科大学学位论文使用授权及知识产权归属承诺本学位论文在导师的指导下,由本人独立完成。本学位论文研究所获发热研究成果,其知识产权归河北医科大学所有。河北医科大学有权对本学位论文进行交流、公开和使用。凡发表与学位论文主要内容相关的论文,第一署名单位为河北医科大学,试验材料、原始数据、申报的专利等知识产权归河北医科大学所有。否则,承担相应的法律责任二级学院}3年河北医科大学研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果,除了文中特别加以标注等内容,文中不包含其他入已经发表或撰写的研究成果,指导教师对此进行了审定。本论文由本人独立撰写,文责自负。研究生签名弓鬻毋即噼罗导师签章弘『3年月歹目目录中文摘要...1英文摘要4研究论文冬春季小儿下呼吸道感染病原体及炎症标志物分析前言8骨lJ吞.8材料与方法8结果...12附图14附表15讨论17结论22参考文献24综述儿童下呼吸道感染的病毒病原学研究进展27致谢36个人简历37中文摘要冬春季JJL下呼吸道感染病原体及炎症标志物分析中文摘要目的了解石家庄及周边地区冬春季小儿下呼吸道感染的病原分布特点,及其与炎症标志物血超敏C.反应蛋白hsCRP、白细胞和中性粒细胞比例的关系,为临床合理用药提供依据。方法研究对象为2011年1月至2011年5月期间,在河北医大第二医院儿科住院的下呼吸道感染患儿84例,其中男56例,女28例。将所有研究对象按年龄分为三组婴儿组小于l岁4l例,幼儿组13岁26例,儿童组大于3岁17例。所有研究对象均于住院次日,抽取静脉血2ml采用间接免疫荧光法测定九种常见呼吸道病原体抗体。包括五种呼吸道病毒呼吸道合胞病毒Respiratorysyncytialvirus,RSV、甲型流感病毒InfluenzaAvirus,IFVA、乙型流感病毒InfluenzaBvirus,rFVa虱J流感病毒Parainfluenzavirus,PIV及腺病毒Adenovirus,ADV四种非典型病原体肺炎支原体mycoplasmapneumoniae,MP、肺炎衣原体Chlarnydiapneumoniae,CPn、嗜肺军团菌1型Legionellapneumopilatype1,LP1、Q热立克次体Richettsiaquery,QFR。同时采末梢血送检其血常规及血超敏C.反应蛋白hsCRP。比较九种病原体的分布情况以及其与年龄、性别相关的流行特点。并按检测结果将患儿分为RSVIgM阳性组、MP.IgM阳性组2组,同时选取抗体阴性且hsCRP升高者作为对照组,分析比较各组间hsCI强、白细胞计数及中性粒细胞比例的关系。结果用SPSS13.0软件包进行统计学处理,应用t检验、卡方检验、秩和检验等方法,数据服从正态性分布的用均数士标准差xs表示,非正态分布的用中位数四分位数间距表示,P0.05男性患儿非典型病原阳性率为19.64%18/56,女性患儿非典型病原阳性率为17.86%5/28,差异无统计学意义PO.05。3常见病毒、非典型病原体及混合感染的分布与年龄的关系此次研究对象共84例,年龄为1.01.98岁,其中最小43天,最大11岁。其中婴儿组人数多于儿童组。非典型病原阳性率婴幼儿组小于三岁为7.46%5/67,儿童组为64.71%11/17,儿童组非典型病原检出率显著高于婴幼儿,差异有统计学意义X2为1.187,P0.05。4RSVIgM抗体阳性率以婴儿组最高,为51.2%,婴儿组与儿童组分别为11.54%3/26和11.76%2/17,差异有统计学意义x2为7.207,P0.05MP.IgM抗体阳性率以儿童组最高占64.7%11/17,而婴幼儿小于三岁为7.46%5/67,差异有统计学意义X2为1.187,P0.05。儿童组乙型流感病毒阳性率略高于其他两组。5MP.IgM阳性组hsCRP、白细胞数值及中性粒细胞比例均低于细菌感染组RSVIgM阳性组hsCRP、白细胞数值及中性粒细胞比例均明显低于细菌感染组以上差异均具有统计学意义P0.05。结论1本地区冬春季下呼吸道感染病毒病原以呼吸道合胞病毒为主,其次为乙型流感病毒和副流感病毒。呼吸道合胞病毒感染多见于婴儿期。非典型病原体以肺炎支原体感染为主,年龄多为以大于三岁的儿童。混合感染以肺炎支原体合并其他病毒感染为主。2呼吸道合胞病毒RSV是导致本地区婴儿组冬春季下呼吸道感染的主要病原体肺炎支原体引起儿童组下呼吸道感染的主要病原体肺炎支原体感染可导致血hsCRP、白细胞、中性粒细胞比例升高。呼吸道合胞病毒感染时血hsCRP、白细胞、中性粒细胞比例显著低于细菌感染组。3本实验通过间接免疫荧光法检测呼吸道常见的九项非细菌致病原IgM抗体,具有特异性强、敏感性高、重复性好、操作简便、快速的优点,可作为感染的早期诊断指标。中文摘要英文摘要▲●●Analysis0IC0mmonpathogenandinflammatorymarkersofchildnwithlnnammatorymarkersOlchildrfnwithlow.errespiratorytractinfectioninwinterandspringObjectiveTounderstandthestatusoftheetiologicspectrumofhospitalizedchildrenwithacutelowerrespiratorytractinfectionALRDinwinterandspring,provideabasisforvirologicaldiagnosisofchildrenwithAL砌in■●●■●●blalazlauangandsurroundlnl乏areas.Methods84casesofchildrenwithALRlwerecollectedastheresearchobject,whowerehospitalizedinthePediatricDepartment,thesecondhospitalofHebeiMedicalUniversityfromJanuary2011toMay2011,including56boysand28girls.Allofthesubjectsweredividedintothreegroupsgroupofinfants1essthanlyearoldin41cases,thechildcaregroup1to3yearsoldin26cases,thegroupofchildrenmorethan3yearsofagein17cases.Allthecaseswerecollectedthevenousblood2m1forthetestofninecommonrespiratorypathogenantibodiesusingindirectimmunofluorescencethenextdayofhospitalization,includingthefiverespiratoryvirusesrespiratorysyncytialvirusRSV,influenzaAvirusIFVA,influenzaBvirusIFVBandparainfluenzavirusPIV,adenovirusADVfouratypicalpathogensMycoplasmapneumoniaMP,ChlamydiapneumoniaCpn,LegionellapneumophilatypeILP1,RichettsiaqueryQFR.Andwecollectedtheperipheralbloodf.ortlletestofthebloodroutineandhighsensitivityCreactiveproteinhsCP,2.Viewedthedistributionofninekindsofpathogensaswellasitspopularfeaturesrelatedtoage,sex.DividedthecasesintoRSVIgMpositivegroupandMPIgMpositivegroup.Chosethecaseswhichwerenegativebutwithhi曲hsCRPasthecontrolgroup.Comparethedifference.sofhsCRPandwhitebloodcells,neutrophilsratioamongthethreegroups.AllstatisticalanalyseswereperformedwithstatisticalsoftwareSPSS13.0,applyedttest,ranksumtest,chisquaretestandSOon.Dateswhich4英文摘要werenormallydistributedwereshowedasmeanstandarddeviationx士s,otherswereshowed懿medianinterquartilespacing.P0.05WaSconsideredstatisticallysignificant.IfhsCRPO.05mg/L,wecalculatedit舔O.04mg/L.Results1.Childrenofsubjectsofthe84caSes,thepathogenantibodyWaSpositivein47,Ling.%47/84piratoryfibodyposmvem4/caSesaccountingIor559547/84resoiratorvvirusantibodv。.%LWaSpositivein38caSes,accountingfor45.24%38/84singlevirusantibodywaspositivein31cases,accountingfor36.9%31/84,andRSVantibodypositiveaccountedfor21.43%18/84.IFⅦaccountedfor13.1%11/84,PIVaccountedfor2.38%2/84.Atypicalpathogensantibodywaspositivein16cases,accountingfor19.05%16/84,allthecaseswere脚antibodypositive,ofwhichthesingleⅧantibodypositiveWasin9cases,accountedforl0.71%9/84.Themixedinfectionviralandatypicalpathogensinmixedinfectionswasin8cases,accountingfor9.52%8/84,allthecaseswereNmmergeotherviralinfections.2田1erelationshipbetweengenderandthepositiverateofthecommonvirusesandatypicalpathogenthemalechildrenwithviruspositiverateWas44.64%25/56,andthefemalechildrenwithviruspositiverateWaS46.43%13/28,therewasnostatisticallydifferencePO.05themalechildrenwithatypicalpathogenpositiveratewas19.64%18/56,andthefemalechildrenwithatypicalpathogenpositiveratewas17.86%5/28,therewasnostatisticallydifferencePO.05.3nerelationshipbetweenageandthedistributionofcommonviruses,atypicalpathogensandmixedinfectionThe咖dyof84patients,ageWas1.01.98years,ofwhichof43days,thebigg~yearold.硼.ypicalyearsotwlalclaaminimumOt43thebiKgest11yearoldheatypical.,.。Ipathogenspositiverateininfantandyoungerchildrengroup1essthan3yearsoldwas7.46%5/67,andthatinchildrenSgroupWaS64.71%11/17,,nlechildrengroupatypicalpathogensdetectionrateWaSsignificantlyhigherthaninfants,thedifferenceWaSstatisticallysignificantXzwas1.187,PO.05.4TheRSV.IgMantibodypositiverateWaShighestinthegroupofinfants,51.2%,andthechildcaregroupwithchildrengroupwere11.54%3/26and11.76%2/17,thedifferenceWaSstatisticallysignificantXzwas7.207,PO.05theNiPIglViantibodypositiveratewhichWaSaccountedfor英文摘要64.7%11/17,washigherthanchildgroup,accountedfor7.46%5/67,thedifferencewasstatisticallysignificantX21.187,PO.05.ThechildrenSgroupofinfluenzaB。IsitiverateslightlyhigherthantheothertwgroupotIntluBvwusposlUveratewasSllglatlyhiglaerthantheothertwogroups.5ThehsCI心,whitebloodcellvalue,andtheproportionofneutrophilsofM咿IgMpositivegroupwerelowerthanbacterialinfectiongroup.ThehsCRP,WBCvalue,andtheproportionofneutrophilsofRSVIgMpositivegroupweresignificantlylowerthanthebacterialinfectiongroupthesedifferenceswerestatisticallysignificantPO.05.ConclusionlPathogensofthelowerrespiratorytractinfectioninthisregioninwinterandspringweremainlyviruses,andsinglecommonrespiratoryvirusinfection.wasmainlytorespiratorysyncytialvirusinfection,andthen一一■●■一●一●■●■influenzaBvirusandparamtluenzavirus.Kesplratorysyncytlalvirusinfectionismorecommonininfancy.nleinfectionofAtypicalpathogensWaSmainlyMycoplasmapneumoniae,ofwhichthepositiveratewasthehighestinchildrengroup.MixedinfectionviralandatypicalpathogenicmicroorganismsmixedinfectionwasmainlyMycoplasmapneumoniaeassociatedwithotherviralinfections.2RespiratorysyncytialvirusRSVisthemainlypathogenininfantgroupwithlowerrespiratorytractinfectionsinthewinterandspringinthisregion.Mycoplasmapneumoniaeisthemainlypathogeninchildrengroupwithlowerrespiratorytractinfectionsinthewinterandspringinthisregion.MycoplasmanfectionCancadtObloodhsCRP,whitebloodcellsandDneumonlaeinfectionleadbloodhswhiteblood,neutrophilratioelevated.ThehsCRP,WBCvalue,andtheproportionofneutrophilsofRSVIgMpositivegroupweresignificantlylowerthanthebacterialinfectiongroup.3Inthisstudy,weusedindirectimmunofluorescencetodetectthecommonninepathogensspecifieialIgMantibodyofrespiratory.Ithastheadvantagesofhighsensitivity,goodreproducibility,easytooperate,fast,andCanbeasearlydiagnosisofinfection.Key。wordsChildrenwithlowerrespiratorytractinfectionsetiology6英文摘要high。sensitivityCreactiveproteinleukocytesproportionofneutrophils7

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