摘要目的 了解婴儿疑似百日咳的临床特征及病原种类,为疾病的治疗提供参考依据.方法 将2016年11月至2017年8月上海儿童医学中心收治的71例年龄<1岁临床疑似百日咳患儿采集鼻咽拭子或痰标本,通过Filmarray平台检测百日咳鲍特菌及17种病毒.根据结果 分为百日咳组(29例)、类百日咳组(42例),按病情严重程度分为轻症组(50例)、重症组(21例),对各组临床资料进行比较分析.结果71例患儿均以咳嗽为主述入院.百日咳组患儿痉挛性咳嗽发生率、白细胞计数、淋巴细胞比例、混合病毒感染比例均明显高于类百日咳组[18例(62.1％)比9例(21.4％),χ2=12.023,P<0.01;(20.00±8.62)×109/L比(13.42±6.58)×109/L,t=-3.647,P<0.01;(70.38±8.97)％ 比(56.26±20.38)％,t=-3.967,P<0.01;22例(75.9％)比16例(38.1％),χ2=9.836,P<0.01];类百日咳组患儿混合细菌感染率高于百日咳组[13例(31.0％)比3例(10.3％),χ2=4.173,P<0.05].重症组患儿咳嗽后发绀发生率及住院天数明显高于轻症组[12例(57.1％)比12例(24.0％),χ2=7.260,P<0.01;(14.5±7.8)d比(7.0±3.1)d,t=-4.250,P<0.01].百日咳组患儿予大环内酯类、复方磺胺甲恶唑片抗感染,类百日咳组患儿予抗病毒等对症治疗后,67例(94.4％)患儿治愈出院;3例(4.2％)临床症状改善.结论 疑似百日咳患儿的临床特征并不典型,故早期病原学的诊断非常重要.Filmarray检测系统为多重PCR系统,可检测20种病原体,运行时间短,对于病原的早期、快速诊断和合理用药具有很大的辅助指导作用,值得临床推广.

abstractsObjective To investigate the clinical features and pathogenic types of suspected pertussis syndrome in infants,so as to provide reference for the treatment. Methods Seventy-one infants of suspected pertussis in Shanghai Children′s Medical Center from Nov 2016 to Aug 2017 were detected by the Filmarray which can detect Bordetella pertussis and 17 viruses. According to the results,the infants were divided into two groups:pertussis group(n=29) and pertussis-like group(n=42). According to the severity of the dis-ease,they were divided into mild group(n=50) and severe group(n=21). Clinical data was retrospectively analyzed and compared. Results All 71 infants came to the hospital with cough. Paroxysmal cough happened in 18 cases(62. 1％)in pertussis group,more common than that in pertussis-like group[9 cases(21. 4％)] (χ2 =12. 023,P<0. 01),and the WBC count,lymphocyte ratio,the mixed virus infection rate were higher in pertussis group than those in pertussis-like group[(20. 00 ± 8. 62) × 109/L vs. (13. 42 ± 6. 58) × 109/L,t=-3. 647,P<0. 01;(70. 38 ± 8. 97)％ vs. (56. 26 ± 20. 38)％,t = -3. 967,P <0. 01;22 cases(75. 9％) vs. 16 cases(38. 1％),χ2 =9. 836,P<0. 01]. The cases of mixed bacterial infection in pertussis-like group were 13(31. 0％),which was higher than that in pertussis group[3(10. 3％)](χ2 =4. 173,P<0. 05). The incidence of cyanosis was found in 12 cases(57. 1％)in severe group,which was more common than that of mild group[12 cases(24. 0％)](χ2 =7. 260,P<0. 01), and hospitalization days were(14. 5 ± 7. 8) days, which was higher than that in mild group[(7. 0 ± 3. 1)days] (t= -4. 250, P<0. 01). The infants in the pertussis group were given macrolides antibiotics and sulfamethoxazole complex,and the infants in the pertus-sis-like group were treated with antiviral and other specific treatment. Among 71 infants, 67 cases (94. 4％) were cured and 3 cases (4. 2％) were improved. Conclusion The clinical features of suspected pertussis in infants are not typical, so the early pathogenic diagnosis is very important. Filmarray detection system for multi PCR system can detect 20 kinds of pathogens with short operation time,which is very helpful for the early and rapid diagnosis of pathogens and rational use of drugs. It is worthy of clinical promotion.