摘要
目的 探讨儿童侵袭性肺炎链球菌病(IPD)临床特征及重症早期预警指标.方法 回顾性收集2007年1月至2021年12月该院至少1次血培养分离出肺炎链球菌(Sp)的101例IPD住院患儿病例资料,根据患儿住院期间是否入住儿童重症监护病房(PICU),将其分为PICU组(35例)和普通病房组(66例),对比分析两组一般临床资料、感染类型、药敏试验、菌株血清型鉴定结果.结果 与普通病房组比较,PICU组男性、合并神经系统疾病和缺铁性贫血占比、冬季发病率,意识障碍、惊厥、呼吸困难、心率增快、呕吐和腹泻发生率,外周血中性粒细胞百分比、C反应蛋白(CRP)、乳酸脱氢酶(LDH)水平,Hb<90 g/L、LDH>700 U/L、肌酸激酶同工酶-MB(CK-MB)异常、细菌性脑膜炎、脓毒症及重症肺炎占比更高,体重第3～97百分位、支气管肺炎、无病灶血流感染占比及WBC、Hb、白蛋白水平更低,差异有统计学意义(P<0.05).该研究鉴定出11种IPD血清型,排名前5依次为6B、14、19F、23F和19A.十三价肺炎链球菌结合疫苗(PCV13)可覆盖96.9％IPD血清型.多因素logistic回归分析显示,入院时患儿出现意识障碍、惊厥、中性粒细胞百分比增高、Hb<90 g/L、LDH>700 U/L及CK-MB异常提示IPD患儿病情危重,为入住PICU的预警指标(P<0.05).结论 IPD重症患儿早期缺乏特异性预警指标,PCV13覆盖率高.
Abstract
Objective To investigate the clinical features in children with invasive pneumococcal disease (IPD) and early warning indicators of severe case.Methods The case data of 101 children inpatients with IPD isolated Streptococcus pneumoniae (Sp) at least once blood culture in this hospital from January 2007 to De-cember 2021 were collected retrospectively.The children patients were divided into the pediatric intensive care unit (PICU) group (35 cases) and general ward group (66 cases) according to whether or not entering PICU during hospitalization.The general clinical data,infection types and results of drug sensitivity test and bacteri-al strain serotype identification were compared between the two groups and analyzed.Results Compared with the general ward group,the male proportion,proportions of complicating nervous system disease and iron-defi-ciency anemia,winter incidence rate,disturbance of consciousness,convulsion,dyspnea,heart rate increase,oc-currence rate of vomiting and diarrhea,proportion of peripheral blood neutrophilic granulocytes,C reactive protein (CRP),lactic dehydrogenase (LDH) level,Hb<90 g/L,LDH>700 U/L,creatine kinase isoenzyme-MB (CK-MB) abnomality,proportions of bacterial meningitis,sepsis and severe pneumonia in the PICU group were higher,the proportion of 3-97 percentile of body weight,bronchopneumonia and no-focus blood stream infection were lower,WBC,Hb and albumin level were lower,and the differences were statistically significant (P<0.05).Eleven kinds of serotypes were identified in this study,ranking the top five in order were 6B,14,19F,23F and 19A.Pneumococcal 13-valent conjugate vaccine (PCV13) could cover 96.9％ of the IPD sero-types.The multivariate logistic regression analysis showed that consciousness disturbance,convulsion,per-centage of neutrophils increase,Hb<90 g/L,LDH>700 U/L and CK-MB abnormality indicated the condition of IPD children patients was critical,which was the early-warning indicator of entering PICU (P<0.05).Con-clusion Severe IPD lacks the early specific early-warning indicator,and the cover rate of PCV13 is high.
维普
万方数据