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目的了解大叶性肺炎与支气管肺炎在临床特点和病原学方面的差异。方法选取2005年12月-2007年12月住院的100例大叶性肺炎患儿及200例支气管肺炎患儿。入院时采血进行血清定量酶ELISA检测肺炎支原体(MP)、衣原体(CP)抗体。第2天早晨应用一次性无菌吸痰管,利用负压抽吸咽喉部未被污染的痰液,进行细菌培养,直接免疫荧光法检查呼吸道常见的7种病毒,并行MP DNA、CP DNA检查,结合临床表现及胸片特点进行分析。结果大叶性肺炎以年长儿发病为主,临床以发热、咳嗽为特点,肺部体征不明显,胸片均表现为一个肺叶炎症,以右侧为多,实验室检查显示血清MP感染阳性率为61.0%;支气管肺炎发病以婴幼儿为主,临床以咳喘及卡他症状多见,肺部以痰鸣音和喘鸣音为主,均表现为两肺的点片状阴影,病原体仍以细菌居第1位。结论支气管肺炎患儿除在好发年龄、临床及胸片特点上与大叶性肺炎患儿有明显差异外,二者的病原谱构成亦存在明显差异。支气管肺炎患儿最主要的病原体是细菌,而大叶性肺炎患儿MP感染率为61.0%,与以往传统的病菌谱发生了巨大改变,且婴幼儿MP感染率有显著增高趋势。
Objective To understand the clinical features and etiology of lobar pneumonia and bronchial pneumonia. Methods 100 children with lobar pneumonia and 200 children with bronchopneumonia admitted to hospital from December 2005 to December 2007 were selected. Serum samples were collected at admission for enzyme-linked immunosorbent assay (ELISA) to detect mycoplasma pneumoniae (MP) and chlamydia (CP) antibodies. On the second morning, a disposable sterile suction tube was used. Negative pressure was used to aspirate the uncontaminated sputum in the larynx for bacterial culture. Direct immunofluorescence was used to examine the seven common respiratory viruses. MP DNA and CP DNA were also examined , Combined with clinical manifestations and chest X-ray analysis. Results The incidence of lobar pneumonia was mainly in elderly children. The clinical features of fever and cough were not obvious in the lungs. The chest radiograph showed a lobular inflammation, which was more on the right side. Laboratory tests showed positive MP infection The rate was 61.0%. The incidence of bronchial pneumonia was mainly in infants and young children. The clinical symptoms of cough and catarrhal were more common. The lungs mainly consisted of phlegm and wheeze, showing patchy shadows of both lungs and pathogens The bacteria still ranks first. Conclusions In addition to the significant difference in age, clinical features and chest radiograph in patients with bronchopneumonia and children with lobar pneumonia, there are also significant differences in the composition of the pathogenic spectrum between the two groups. The most important pathogens in children with bronchopneumonia were bacteria, while the infection rate of MP in children with lobar pneumonia was 61.0%, which greatly changed from the traditional spectrum of bacteria, and the MP infection rate in infants and young children was significantly increased.