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201 1年1月至201 1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(Respiratory syncytial virus，RSV)、甲型流感病毒(Influenza A virus，IFVA)、乙型流感病毒(Influenza B virus，rFVa)虱J流感病毒(Parainfluenza virus，PIV)及腺病毒(Adenovirus，ADV)：四种非典型病原体：肺炎支原体(mycoplasma pneumoniae，MP)、肺炎衣原体(Chlarnydia pneumoniae，CPn)、嗜肺军团菌1型(Legionella pneumopilatype 1，LP 1)、Q热立克次体(Richettsia query,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RSV-IgM阳性组、MPIgM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SPSS 130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(x+s)表示，非正态分布的用中位数(四分位数间距)表示，PO05为差异有统计学意义。(HsCRP005)；男性患儿非典型病原阳性率为1964(1856)，女性患儿非典型病原阳性率为1786(528)，差异无统计学意义(PO05)。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10(198)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746(567)，儿童组为6471(1 117)，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1187，P005)。4RSV-IgM抗体阳性率以婴儿组最高，为512，婴儿组与儿童组分别为1154(326)和1176(217)，差异有统计学意义(x2为7207，P005)；MPIgM抗体阳性率以儿童组最高占647(1 117)，而婴幼儿(小于三岁)为746(567)，差异有统计学意义(X2为1187，P005)。儿童组乙型流感病毒阳性率略高于其他两组。5 MPIgM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；RSV-IgM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(P005)。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 - Analysis 0I C0mmon pathogen andinflammatory markers of childn withlnnammatorymarkers Ol childrfn withlower respiratory tract infection in winter and springObjective：To understand the status of the etiologic spectrum of hospitalizedchildren with acute lower respiratory tract infection(ALRD in winter andspring，provide a basis for virological diagnosis of children with AL砌in bla!lazlauang and surroundlnl乏areasMethods：84 cases of children with ALRl were collected as the researchobject,who were hospitalized in the Pediatric Department，the second hospitalof Hebei Medical University from January 20 1 1 to May 20 1 1，including 56boys and 28 girlsAll of the subjects were divided into three groups：group ofinfants(1ess than l year old)in 4 1 cases，the child care group(1 to 3 years old)in 26 cases，the group of children(more than 3 years of age)in 1 7 casesAllthe cases were collected the venous blood 2m1 for the test of nine commonrespiratory pathogen antibodies using indirect immunofluorescence the nextday of hospitalization，including the five respiratory viruses：respiratorysyncytial virus(RSV)，influenza A virus(IFVA)，influenza B virus(IFVB)andparainfluenza virus(PIV)，adenovirus(ADV)；four atypical pathogens：Mycoplasma pneumonia(MP)，Chlamydia pneumonia(Cpn)，Legionellapneumophila type I(LP 1)，Richettsia query(QFR)And we collected theperipheral blood for tlle test of the blood routine and high-sensitivityCreactive protein(hsCP,2)Viewed the distribution of nine kinds ofpathogens as well as its popular features related to age，sexDivided the casesinto RSVIgM positive group and MPIgM positive groupChose the caseswhich were negative but with hi曲hsCRP as the control groupCompare thedifferences of hsCRP and white blood cells，neutrophils ratio among the threegroupsAll statistical analyses were performed with statistical softwareSPS S 1 30，applyed t test，rank sum test，chisquare test and SO onDates which4英文摘要were normally distributed were showed as mean+standard deviation(x士s)，others were showed懿median(interquartile spacing)P005 WaS consideredstatistically significant(If hsCRPO05mgL，we calculated it舔O04mgL)Results：1Children of subjects of the 84 caSes，the pathogen antibody WaSpositive in 47 ，Ling-(4784)； ；piratory fibodyposmvem 4caSes accounting Ior 55 95 4784 resoiratorv virus antibodv。 L )：WaS positive in 38 caSes，accounting for 4524(3884)；single virus antibodywas positive in 3 1 cases，accounting for 369(3 184)，and RSV antibodypositive accounted for 2143(1884)IFaccounted for 131(1 184)，PIV accounted for 238(284)Atypical pathogens antibody waspositive in 1 6 cases，accounting for 1 905(1 684)，all the cases were脚antibody positive，of which the singleantibody positive Was in 9 cases，accounted forl 07 1(984)The mixed infection(viral and atypicalpathogens in mixed infections)was in 8 cases，accounting for 952(884)，all the cases were Nm merge other viral infections2田1e relationship betweengender and the positive rate of the common viruses and atypical pathogen：themale children with viruspositive rate Was 4464(2556)，and the femalechildren with viruspositive rate WaS 4643(1 328)，there was no statisticallydifference(PO05)；the male children with atypical pathogenpositive rate was1 964(1 856)，and the female children with atypical pathogenpositive ratewas 1 786(528)，there was no statistically difference(PO05)3 nerelationship between age and the distribution of common viruses，atypicalpathogens and mixed infection：The咖dy of 84 patients，age Was 10(198)years，of which of 43days，the bigg year-old硼 ypicalyearsot wlalcla a minimum Ot 43 the biKgest 1 1-year-old he atypical ， 。Ipathogens positive rate in infant and younger children group(1ess than 3 yearsold)was 746(567)，and that in childrenS group WaS 6471(1 117)，nlechildren group atypical pathogens detection rate WaS significantly higher thaninfants，the difference WaS statistically significant(Xz was 11 87，PO05)4The RSVIgM antibody positive rate WaS highest in the group of infants，5 12，and the child care group with children group were 1154(326)and1176(21 7)，the difference WaS statistically significant(Xz was 7207，PO05)；the NiPIglVi antibody positive rate which WaS accounted for英文摘要647(1 117)，was higher than child group，accounted for 746(567)，thedifference was statistically significant(X2 11 87，PO05)The childrenSgroup of influenza B。 I；)sitive rate slightly higher than the other tw(groupot Intlu B vwus-poslUve rate was Sllglatly higlaer than the other twogroups5 The hsCI心，white blood cell value，and the proportion ofneutrophils of M咿-IgM positive group were lower than bacterial infectiongroupThe hsCRP，WBC value，and the proportion of neutrophils ofRSVIgM positive group were significantly lower than the bacterial infectiongroup；these differences were statistically significant(PO05)Conclusion：l Pathogens of the lower respiratory tract infection in this regionin winter and spring were mainly viruses，and single common respiratory virusinfectionwas mainly to respiratory syncytial virus infection，and then一一 一 一 influenza Bvirus and paramtluenza virus Kesplratory syncytlal virusinfection is more common in infancynle infection of Atypical pathogens WaSmainly Mycoplasma pneumoniae，of which the positive rate was the highest inchildren groupMixed infection(viral and atypical pathogenicmicroorganisms mixed infection)was mainly Mycoplasma pneumoniaeassociated with other viral infections2 Respiratory syncytial virus(RSV)is the mainly pathogen in infant groupwith lower respiratory tract infections in th