摘要
目的了解河北省儿童医院血培养阳性患儿病原菌的分布及外周血淋巴细胞亚群的变化情况,为临床血流感染患者的诊断及治疗提供参考依据。方法收集河北省儿童医院门诊、急诊及住院患者血培养阳性患儿974例进行细菌培养及鉴定。其中468例患儿进行了淋巴细胞亚群检测,排除混合感染和共同感染,最终纳入219例单纯血培养阳性患儿作为病例组,250例体检儿童作为健康对照组,采用病例对照研究,分析血流感染患儿外周血淋巴细胞亚群的变化情况。结果2022年血培养分离菌株中居前五位的依次为表皮葡萄球菌(25.20%)、人葡萄球菌(11.20%)、金黄色葡萄球菌(9.00%)、肺炎链球菌(7.00%)和肺炎克雷伯菌(6.40%);2023年血培养分离株中居前五位的血培养阳性菌株依次为表皮葡萄球菌(23.21%)、人葡萄球菌(17.93%)、肺炎克雷伯菌(11.60%)、金黄色葡萄球菌(7.59%)和大肠埃希菌(6.75%)。革兰阳性菌感染患儿和血培养阳性患儿外周血淋巴细胞亚群的变化一致,均表现为外周血总T细胞、辅助性T细胞、抑制性T细胞和双阴性T淋巴细胞百分比明显低于健康对照组(P<0.001),而B淋巴和NK细胞百分比则明显高于健康对照组(P<0.001)。革兰阴性菌感染患儿外周血总T细胞、抑制性T细胞和双阴性T淋巴细胞百分比明显低于健康对照组(P<0.001),外周血辅助性T细胞和双阳性T淋巴细胞、B淋巴和NK细胞百分比与健康对照组比较差异无统计学意义(P>0.05)。结论革兰阳性菌和革兰阴性菌血流感染患儿均存在细胞免疫功能抑制现象。但是,与革兰阴性菌血流感染患儿不同,革兰阳性菌血流感染患儿还存在体液免疫和固有免疫功能的异常激活。
Objective To understand the distribution of pathogenic bacteria and changes in peripheral blood lymphocyte subpopulations in children with positive blood cultures in Hebei Children′s Hospital,and to provide a reference basis for the diagnosis and treatment of patients with bloodstream infections in clinical settings.Methods Nine hundred and seventy-four children with positive blood cultures were collected from Outpatient Department,Emergency Department and Inpatient Department of Hebei Children′s Hospital for bacterial culture and identification.Among them,468 children were tested for lymphocyte subpopulations,and mixed infections and co-infections were excluded.Finally,219 children with purely positive blood cultures were finally included as a case group,and 250 children undergoing physical examination were included as a healthy control group.A case-control study was used to analyse the changes in the peripheral blood lymphocyte subpopulations in children with bloodstream infections.Results In 2022,the top five strains isolated from blood cultures were Staphylococcus epidermidis(25.20%),Staphylococcus hominis(11.20%),Staphylococcus aureus(9.00%),Streptococcus pneumoniae(7.00%),and Klebsiella pneumoniae(6.40%).In 2023,the top five positive strains isolated from blood culture were Staphylococcus epidermidis(23.21%),Staphylococcus hominis(17.93%),Klebsiella pneumoniae(11.60%),Staphylococcus aureus(7.59%),and Escherichia coli(6.75%).Changes in peripheral blood lymphocyte subpopulations were consistent between children with Gram-positive bacterial infections and those with positive blood cultures,both of which showed that the percentages of peripheral blood total T cells,helper T cells,suppressor T cells,and double-negative T lymphocytes were significantly lower than those of healthy control group(P<0.001),whereas the percentages of B-lymphocytes and NK cells were significantly higher than those of healthy control group(P<0.001).Percentages of total peripheral blood T cells,suppressor T cells and double-negative T lymphocytes in children with Gram-negative bacterial infections were significantly lower than those in the healthy control group(P<0.001),and the differences in percentages of peripheral blood helper and double-positive T lymphocytes,B lymphocytes and NK cells were not statistically significant when compared with those in the healthy control group(P>0.05).Conclusion Both Gram-positive and Gram-negative bloodstream infections are associated with cellular immune suppression.However,unlike children with Gram-negative bloodstream infections,children with Gram-positive bloodstream infections also have abnormal activation of humoral and intrinsic immune functions.
作者
郭巍巍
赵梦川
严小桐
刘颖业
刘腾
崔晓薇
GUO Wei-wei;ZHAO Meng-chuan;YAN Xiao-tong;LIU Ying-ye;LIU Teng;CUI Xiao-wei(Department of Pediatric Research Institute,Hebei Children′s Hospital,Shijiazhuang 050031,China;Department of Laboratory,Hebei People′s Hospital,Shijiazhuang 050051,China)
出处
《河北医科大学学报》
CAS
2024年第11期1330-1335,共6页
Journal of Hebei Medical University
基金
河北省政府资助临床医学优秀人才培养项目(2021030)。
关键词
感染
血培养
儿童
病原菌
infections
blood culture
child
pathogens
