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目的研究反复呼吸道感染(RRI)患儿的病原菌分布及免疫机制。方法观察组选择2007年4月-2008年4月武汉市儿童医院呼吸科收治的RRI患儿50例。男26例,女24例。分为3个亚组:6个月～2岁组(28例),3～5岁组(15例),6～12岁组(7例)。健康对照组50例。年龄6个月～12岁。入院次日凌晨,上呼吸道感染患儿用清洁无菌棉球取鼻咽部分泌物,置无菌容器中立即进行病原菌检测;下呼吸道感染患儿用抽吸法采集下呼吸道分泌物置无菌容器中,并立即进行病原菌检测。统计重复感染某一病原菌的例数。观察组和健康对照组儿童抽空腹静脉血,检测其细胞免疫(CD3+、CD4+、CD8+、CD4+/CD8+)及体液免疫(IgA、IgM、IgG、C3、C4)。结果 6个月～2岁组共检测标本302例次,分离出病原菌135株,阳性率42.2%,其中重复感染者达25例;3～5岁组共检测标本137例次,分离出病原菌47株,阳性率34.3%,其中重复感染者7例;6～12岁组共检测标本54例次,分离出病原菌16株,阳性率29.6%,重复感染者2例次。RRI患儿易感染的前5位细菌分别是铜绿假单胞菌、肺炎克雷伯杆菌、金黄色葡萄球菌、大肠埃希菌和肺炎链球菌。观察组CD3+、CD8+和CD4+/CD8+均明显低于健康对照组(Pa<0.05),IgM、IgG及C3亦显著低于健康对照组(Pa<0.05)。结论 RRI患儿免疫功能低下,感染同一病原菌的概率较大,且年龄越小重复感染的概率越大。
Objective To study the distribution of pathogens and immune mechanism in children with recurrent respiratory tract infection (RRI). Methods 50 cases of RRI children admitted to Department of Respiratory Diseases, Wuhan Children ’s Hospital from April 2007 to April 2008 were selected in the observation group. 26 males and 24 females. Divided into three subgroups: 6 months to 2 years old group (28 cases), 3 to 5 years old group (15 cases), 6 to 12 years old group (7 cases). Healthy control group of 50 cases. Aged 6 months to 12 years old. On the morning of admission, children with upper respiratory tract infection took nasopharyngeal secretions with clean sterile cotton balls and placed in aseptic containers immediately for pathogen detection; children with lower respiratory tract infection were collected by suction to collect the lower respiratory secretions and placed in sterile containers , And immediately tested for pathogens. Statistics of the number of cases of repeated infection of a pathogen. The fasting venous blood was taken from the observation group and the healthy control group to detect the cellular immunity (CD3 +, CD4 +, CD8 +, CD4 + / CD8 +) and humoral immunity (IgA, IgM, IgG, C3, C4). Results A total of 302 samples were detected from 6 months to 2 years old, 135 strains of pathogens were isolated, the positive rate was 42.2%, of which 25 cases were repeated infections; 137 cases were detected in 3 to 5 years old group and 47 The positive rate was 34.3%, of which 7 were repeatedly infected. Among 6 to 12 years old, 54 samples were detected and 16 pathogens were isolated. The positive rate was 29.6%, and the number of repeated infections was 2. The top five bacteria susceptible to RRI were Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, Escherichia coli and Streptococcus pneumoniae, respectively. The levels of CD3 +, CD8 + and CD4 + / CD8 + in the observation group were significantly lower than those in the healthy control group (Pa <0.05), and the levels of IgM, IgG and C3 in the observation group were significantly lower than those in the healthy control group (Pa0.05). Conclusion The immunocompromised children with RRI have a higher probability of infection with the same pathogen, and the younger the children, the greater the probability of repeated infections.