目的 了解苏州地区肺炎支原体肺炎(MPP)患儿混合感染情况,为MPP混合感染的诊治提供依据。方法 选取2015年1月—2016年12月间于苏州大学附属儿童医院呼吸科住院的815例MPP患儿作为研究对象,进行多病原检测,并对临床资料进行分析。结果 1)815例MPP患儿中混合感染350例,其中混合病毒199例,混合细菌91例,同时混合病毒细菌60例。病毒病原以鼻病毒、博卡病毒、呼吸道合胞病毒最常见。细菌病原以肺炎链球菌、流感嗜血杆菌最常见。2)混合病毒感染组较单一感染组年龄小,更易合并胃肠症状、喘息、呼吸困难,发生重症肺炎比例高(χ²=27.126,12.093,8.466,5.031,7.267, P＜0.05)。3)混合细菌感染组较单一感染组年龄小、热程长、更易出现呼吸困难,WBC＞10×10⁹/L比例高(χ²=5.392,4.944,4.155,4.742,P＜0.05)。4)同时混合病毒细菌感染组较单一感染组年龄小,热程长,出现喘息、呼吸困难和WBC＞10×10⁹/L比例高(χ²=5.245、5.647、4.161、 8.221、6.568, P＜0.05)。胸片示大片状改密影,胸腔积液及肺不张比例高(χ²=4.946,5.382,P<0.05)。5)多因素分析显示,年龄＜3岁(OR=2.23,95%CI:1.516～3.279)、出现胃肠症状(OR=1.583,95%CI:1.020～2.455)为MPP混合病毒感染的独立危险因素。年龄＜3岁(OR=1.841,95%CI:1.131～2.999),发热＞10 d (OR=2.492,95%CI:1.191～5.212)、WBC＞10×10⁹/L(OR=1.648,95%CI:1.038～2.616)为MPP混合细菌感染的独立危险因素。年龄＜3岁(OR=2.345,95%CI:1.250～4.399)、发热＞10 d(OR=3.291,95%CI:1.304～8.307)、合并呼吸困难(OR=4.427,95%CI:1.135～17.268)、WBC＞10×10⁹/L(OR=2.39,95%CI:1.357～4.212)为MPP同时混合病毒细菌感染的独立危险因素。结论 MPP住院患儿中混合感染占一定比例,主要混合的病原体是病毒,其次是细菌;混合感染的临床特征及高危因素与具体混合感染的病原有关。

Objective To understand the mixed infection of children with mycoplasma pneumoniae pneumonia(MPP) in Suzhou,in order to provide basis for the diagnosis and treatment of MPP mixed infection.Methods A total of 815 inpatients with MPP were selected from January 2015 to December 2016 in the Department of Respiration in Children′s Hospital of Soochow University. Multiple pathogens were detected in 815 inpatients,and clinical data were analyzed. Results 1) In 815 cases of MPP,350 cases had mixed infection,including 199 cases with virus infection,91 cases with bacterial infection,60 cases with virus and bacterial infection. The common virus pathogens included HRV,HBoV and RSV. The common bacterial pathogens were streptococcus pneumonia(SP) and haemophilus influenza(Hi). 2) Compared with the single infection group,the mixed virus infection group was younger,had a higher proportion of wheezing,dyspnea and gastrointestinal symptoms and was more likely to have severe pneumonia(χ²=27.126,12.093,8.466,5.031,7.267,P＜0.05).3)The mixed bacterial infection group was younger,with longer fever duration,and the proportions of dyspnea and WBC＞10×10⁹/L in mixed bacterial infection group were significantly higher than those in single infection group(χ²=5.392,4.944,4.155,4.742,P＜0.05). 4) The MPP with virus and bacterial infection group was younger,with longer fever duration,and the proportions of wheezing,dyspnea and WBC＞10×10⁹/L were significantly higher than those in single infection group(χ²=5.245,5.647,4.161,8.221,6.568, P＜0.05). X ray indicated that the proportions of hydrothorax and pulmonary dilatation were significantly higher in MPP with virus and bacterial infection group(χ²=4.946,5.382,P＜0.05).5) Logistic regression analysis showed that risk factors for MPP with virus infection included age under 3 years old(OR=2.23,95%CI:1.516—3.279) and gastrointestinal symptoms(OR=1.583,95%CI:1.020—2.455). Risk factors for MPP with bacterial infection were age under 3 years old(OR=1.841,95%CI:1.131—2.999),having fever > 10 days(OR=2.492,95%CI:1.191—5.212)and WBC＞10×10⁹/L(OR=1.648,95%CI:1.038—2.616). Age under 3 years old(OR=2.345,95%CI:1.250—4.399),having fever＞10 days(OR=3.291,95%CI:1.304—8.307), dyspnea(OR=4.427,95%CI:1.135—17.268) and WBC＞10×10⁹/L(OR=2.39,95%CI:1.357—4.212) were found to be the risk factors for MPP with virus and bacterial infection. Conclusions There is a certain proportion of mixed infection among hospitalized children with MPP,and the main mixed pathogen of MPP is virus,followed by bacteria. The clinical manifestations and risk factors of mixed infection are related to the pathogen of mixed infection.