RSV感染足月新生儿肺炎临床表现及实验室检查分析

摘要

目的 探讨呼吸道合胞病毒(RSv)感染足月新生儿肺炎的临床表现及实验室检查结果的特点.方法 随机选取2013年1月至2015年12月义乌市妇幼保健计划生育服务中心儿科收治的足月新生儿肺炎患儿200例,采用直接免疫荧光法对其进行RSV抗原检测,根据检测结果将其分为RSV阳性组和RSV阴性组,分析两组患儿的临床表现及实验室检查结果.结果 在200例足月新生儿肺炎患儿中,RSV阴性组179例,RSV阳性组21例,感染率达10.50％.两组在喂养方式、分娩方式及年龄上的差异均有统计学意义(x2值分别为4.084、29.007、2.229,均P＜0.05).两组患儿的喘鸣音、细湿性啰音、三凹征、呼吸急促及咳嗽发生率比较差异均有统计学意义(x2值分别为13.195、34.641、15.590、17.378、3.979,均P＜0.05).RSV阳性组患儿x线胸片出现斑片影的比例较RSV阴性组明显降低,而出现肺气肿的比例则明显高于RSV阴性组,经比较差异均有统计学意义(x2值分别为9.926、67.427,均P＜0.05).在治疗与转归方面,患儿全部使用了抗生素,均治愈.结论 足月新生儿感染性肺炎的主要病原体是RSV,顺产及母乳喂养均可在一定程度上降低足月新生儿感染RSV的风险.该类感染性肺炎在临床表现上更易出现肺部啰音、呼吸急促及咳嗽,肺气肿表现则在X线胸片检查上更容易出现.%Objective To explore the clinical manifestations and laboratory analysis of full-term newborns with respiratory syncytial virus (RSV)-infected neonatal pneumonia.Methods Two hundred full-term newborns with pneumonia were randomly selected in pediatrics department of Yiwu Maternal and Child Health Care Family Planning Service Center from January 2013 to December 2015.RSV of them was detected by direct immunofluorescence.According to detection results,they were divided into RSV positive group and RSV negative group to analyze the clinical manifestations and laboratory examination results.Results Among 200 cases,there were 21 cases of RSV positive and 179 cases of RSV negative.The infection rate was 10.50％.There were significant differences between two groups in feeding pattern,delivery mode and age (x2 value was 4.084,29.007 and 2.229,respectively,all P ＜ 0.05).The differences in incidence of wheezing,fine rales,three depression sign,tachypnea and cough were statistically significant (x2 value was 13.195,34.641,15.590,17.378 and 3.979,respectively,all P ＜ 0.05).In RSV positive group the proportion of cases with plaques in X-ray chest film was remarkably lower than that in RSV negative group,but the proportion with emphysema was higher with statistical significance (x2 value was 9.926 and 67.427,respectively,both P ＜ 0.05).In the treatment and outcomes,all of the children used antibiotics and were cured.Conclusion RSV is an important pathogen in full-term newborns with infectious pneumonia.Breasffeeding and eutocia can reduce the incidence of RSV infection to certain extend.Pulmonary rales,tachypnea and cough are common in clinical manifestations,and emphysema is easy to be found in X-ray film.