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中国循证儿科杂志

中国循证儿科杂志 ›› 2019, Vol. 14 ›› Issue (3): 201-204.DOI: 10.3969/j.issn.1673-5501.2019.03.008

• 论著 • 上一篇    下一篇

健康学龄前儿童入幼儿园前后鼻咽部病原学变化的队列研究

罗春绸1, 蔡惠贞2, 张月葵2, 蔡梦云1, 林秀梅1, 刘玲红3, 严琳1, 谢丽琴2   

  1. 福建医科大学附属漳州市医院 漳州,363000;1 儿科,2 护理部,3 外科
  • 收稿日期:2019-03-01 出版日期:2019-06-25
  • 通讯作者: 谢丽琴, E-mail:137759787@qq.com
  • 基金资助:
    福建省自然科学基金项目:2017J01387

Cohort study on pathogenic changes of nasopharyngeal in preschool children before and after going to kindergarten

LUO Chun-chou1, CAI Hui-zhen2, ZHANG Yue-kui2, CAI Meng-yun1, LIN Xiu-mei1, LIU Ling-hong3, YAN Lin1, XIE Li-qin2   

  1. Zhangzhou Hospital Affiliate to Fujian Medical University, Zhangzhou 363000, China; 1 Department of Pediatrics, 2 Department of Nursing, 3 Surgery
  • Received:2019-03-01 Online:2019-06-25
  • Contact: XIE Li-qin, E-mail: 137759787@qq.com

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摘要： 目的 了解入托儿童第1次上呼吸道感染(AURTIs)咽拭子标本病原学演变。方法 以幼儿园为队列研究现场,以首次入托的学龄前儿童为研究对象,以入幼儿园生活作为暴露因素,于入托前体检时、入托48 h后第1次发生AURTIs时、1个学期结束时(未发生AURTIs的学龄前儿童),用咽拭子采集鼻咽部分泌物,行细菌培养和呼吸道合胞病毒(RSV)、腺病毒(ADV)、流感病毒A型(Iva)、B型(Ivb)、副流感病毒Ⅰ型(PIV Ⅰ)、Ⅱ型(PIV Ⅱ)、Ⅲ型(PIV Ⅲ)病毒、肺炎支原体和衣原体检测。结果 115例学龄前入托儿童进入本文分析,平均 3.4岁。入托前体检时培养出细菌114例,共培养出9种细菌,平均每例(3.3±0.8)种,检出支原体阳性1例(1.1%)。91例(79.1%)在学期期间第1次AURTIs,共培养出12种细菌。第1次AURTIs较入托时肺炎链球菌、流感嗜血杆菌、乙型溶血性链球菌、大肠埃希菌和化脓性链球菌细菌数量鉴定≥3+的例数有所增加。检出支原体和病毒25例(27.5%),其中支原体14例,Iva 5例,PIV Ⅰ、Ivb、ADV各2例。学期结束时24例学龄前儿童未发生AURTIs,共培养出9种细菌,平均每例(3.6±0.5)种;学期结束时较入托时仅化脓性链球菌细菌数量鉴定≥3+增加了1例,均未检出支原体、衣原体和病毒。115例学龄前健康儿童入托时和24例在学期期间未发生AURTIs的定植菌包括奈瑟菌属、草绿色链球菌、微球菌、革兰阳性杆菌、凝固酶阴性葡萄球菌、肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌、阴沟肠杆菌和化脓性链球菌。结论 79.1%健康学龄前儿童入托后发生AURTIs,以细菌(肺炎链球菌、流感嗜血杆菌、乙型溶血性链球菌、大肠埃希菌和化脓性链球菌)、支原体和病毒(Iva、PIV Ⅰ、Ivb、ADV)感染为主。

关键词: 鼻咽部病原学, 病毒, 上呼吸道感染, 细菌, 学龄前儿童

Abstract: Objective To understand the pathogenic evolution of throat swab specimens of kindergarten children suffering from acute upper respiratory tract infections (AURTIs) for the first time.Methods Kindergarten was taken as the place of a cohort study and the subjects were pre-school children who were enrolled in a kindergarten for the first time. The kindergarten life was taken as the exposure factor. During the physical examination before the enrollment and the first onset of AURTIs after 48 hours of enrollment and at the end of the first semester (pre-school children without AURTIs), nasopharyngeal secretions were collected by throat swabs, and bacteria culture was done and tests were carried out for respiratory syncytial virus (RSV), adenovirus (ADV), influenza virus A (Iva), influenza virus B(Ivb), parainfluenza virus Ⅰ (PIV Ⅰ), parainfluenza virus Ⅱ (PIV Ⅱ), parainfluenza virus Ⅲ (PIV Ⅲ), Mycoplasma pneumoniae and Chlamydia.Results Nine kinds of bacteria were found in 114 of 115 cases with an average age of 3.4 years. One case had (3.3±0.8) kinds of bacteria on average and there was one mycoplasma-positive (1.1%) case. During the semester 91 cases (79.1%) had AURTIs, for the first time the second to sixth onset of AURTIs were 63, 29, 16, 6, and 2 cases respectively and twelve cases developed to lower respiratory tract infection and 1 case to sepsis. Twelve kinds of virus were found after the culture of throat swab specimens of 115 preschool children collected at the time of enrollment. Compared with the time of enrollment, at the first onset of AURTIs there was an increase in the number of Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus hemolyticus, Escherichia coli and Streptococcus pyogenes which were identified ≥3+ increased. There were 25 cases of (27.5%) mycoplasma and virus including 14 cases of mycoplasma, 5 cases of Iva, 2 cases of PIV Ⅰ, Ivb and ADV. AURTIs did not occur in 24 preschool children during the semester. A total of 9 kinds of bacteria were cultured at the time of enrollment, with an average of 3.5±0.7 in each case. At the end of the semester, 9 kinds of bacteria were cultured, with an average of 3.6±0.5 in each case. Compared with the time of enrollment, there was one more case of Streptococcus pyogenes which were identified ≥3+. No mycoplasma, chlamydia and virus were detected. For 115 cases of healthy pre-school children at the time of enrollment and 24 cases without AURTIs during the semester, bacteria colonization included Neisseria, Streptococcus viridans, Micrococcus, Gram-positive bacilli, Coagulase-negative Staphylococcus, Streptococcus pneumoniae, Influenza Haemophilus, Staphylococcus aureus, Enterobacter cloacae and Streptococcus pyogenes.Conclusion Senventy-nine percent of healthy pre-school children have AURTIs after enrollment, mostly infected by bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus hemolyticus, Escherichia coli and Streptococcus pyogenes), Mycoplasma and viruses (Iva, PIV Ⅰ , Ivb, ADV) .

Key words: Bacterial, Nasopharyngeal pathogen, Preschool children, Upper respiratory infection, Virus