目的 了解盐城地区住院儿童社区获得性肺炎(CAP)感染的病原学及临床特征,为盐城地区儿童CAP的防治提供参考依据。方法 回顾性分析2014年10月-2015年9月在盐城市妇幼保健院住院的CAP患儿541例的临床资料。住院期间多病原检测包括:痰常见7种呼吸道病毒抗原、血肺炎支原体(MP)- IgM抗体、血EB四项抗体、痰培养或血培养。结果 病原体阳性检出率为62.8%。MP28.7%,病毒21.8%,细菌16.8%。从单一病原来看,以MP感染率最高(28.7%),其次为呼吸道合胞病毒、肺炎链球菌。>1~5岁龄组及>5~14岁龄组CAP患儿,MP检出阳性率均较高。病毒感染主要发生于1岁以内婴儿。年龄与发热的发生比及高低程度呈正相关,1岁以内年龄组发热比例低(41.6%)且以低热及中等度发热为主,1岁以上年龄组发热比例高(55.6%)以高热为主。CAP患儿5岁以下年龄组咳嗽、喘息气促的发生率明显高于5岁以上儿童;年龄越小肺部体征越明显。1月~1岁龄组CAP胸部影像学主要表现为小斑片影,多为单侧肺受累;>5~14岁龄组患儿则多为大叶受累阴影,多为单侧肺受累。结论 盐城地区住院儿童CAP病原依次为支原体、病毒、细菌。不同年龄段CAP患儿病原体检出率不同。不同年龄和不同病原学感染的儿童CAP的影像学表现各有特点。

Objective To explore the etiology and clinical characteristics in hospitalized children with community-acquired pneumonia(CAP) in Yancheng. Methods Retrospective analysis of the clinical date of 541 chileren with CAP in pediatrics respiratory department of Yancheng Maternity and Child Health Care Hospital from October 2014 to September 2015.Multi pathogen detection during hospitalization included:7 kinds of common respiratory virus antigens,myconplasma(MP)pneumonia IgM antibody,anti-Epstein-Barr virus antiboby,sputum culture or blood culture. Results The pathogen positive detection rate was 62.8%.Mycoplasma infection was 26.8%,virus infection was 21.8%,and bacterial infection was 16.8%.From a single point of view,MP infection rate was the highest (28.7%),followed by respiratory virus,streptococcus pneumonia.MP detection positive rate of children with CAP of 1 to 5 years old group and 5 to 14 years old group were both high.Virus infection mainly occurred in infants under 1 year of age.The age and the occurrence and degree of fever had positive relationship.The proportion of children with fever was lower (41.6%) in the group of less than 1 year old mainly as low and moderate degree,while in the group of more than 1 year old higher (55.6%),fever mainly as high degree.The incidence of cough and wheezing in children with CAP who were under 5 years old was significantly higher than that of group of age more than 5 years old.The younger the age,the more obvious pulmonary signs.Little patchy shadows occurred commonly in infants less than 1 year old as single-lung involved.Large patchy shadows occurred commonly in children between 5 to 14 years old as bilateral lung involved.Pleural effusion and atelectasis occurred. Conclusions The CAP pathogens of the hospitalized children in Yancheng are mycoplasmar,virus,bacteria.The rate of pathogen examination is different in CAP patients of different age groups.Children with CAP of different ages and etiology infection are quite distinct from each other in imaging characteristics.