呼吸道合胞病毒下呼吸道感染与患儿鼻咽部定植菌群的关系

研究鼻咽部定植菌群与呼吸道合胞病毒（RSV）下呼吸道感染患儿病情特点的关系,从微生态角度寻找预防或治疗RSV下呼吸道感染的理论依据。

回顾性分析我院2020年8月1日到2021年10月31日收治的RSV下呼吸道感染患儿,根据鼻咽部分泌物培养结果分为阴性组、阳性组,对比两组患儿临床特点及潮气肺功能检测结果。

1 090例RSV下呼吸道感染患儿中培养阳性者290例（26.58%）,中位数年龄为8个月（3.24个月,14个月）。各年龄层患儿鼻咽部菌群定植率及定植菌群差异有统计学意义（均P＞0.05）。各年龄层患儿鼻咽部定植菌均以肺炎链球菌为主。金黄色葡萄球菌、大肠埃希菌及卡他莫拉菌定植的患儿发热率较低。与喘息相关定植菌为肺炎链球菌、流感嗜血杆菌及金黄色葡萄球菌。与重症相关的定植菌为肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌、大肠埃希菌。与大叶性肺炎发生相关的只有肺炎链球菌。肺炎链球菌及流感嗜血杆菌定植的达峰容积比（Z = −4.12,P＜0.001;Z = −1.99,P = 0.046）与达峰时间比（Z = −4.24,P＜0.001;Z = −1.98,P = 0.047）均低于阴性组。

特定鼻咽部定植菌的存在会影响RSV下呼吸道感染患儿的临床表现,同时降低婴幼儿潮气肺功能检测结果。

     

羊膜腔内感染微生物分布及相关影响因素分析

研究剖宫产术中产妇的感染症状、羊水微生物分布情况及相关影响因素,为该类患者的治疗提供帮助。

采集本院2020年6月至2023年2月于剖宫产术中提取的羊水498份进行细菌培养,根据羊水微生物分布情况和相关因素,综合分析产妇临床感染症状。

498份送检羊水标本中有147份标本检出微生物,总检出率为29.5%（147/498）。498例产妇中有100例术前出现感染症状,检出微生物78株;51例术后出现感染症状,检出微生物34株;8例术后切口感染,检出微生物7株。339例没有临床感染症状的产妇检出微生物28株。羊水微生物的检出率与胎膜早破或试产后人工破膜、产妇自身阴道菌群分布、术前出现感染症状呈显著相关（均P＜0.05）。

对胎膜早破、阴道菌群失调等高危产妇及时送检标本查找病原体,对羊膜腔内感染的早期预防和针对性治疗具有显著意义。

     

哮喘患儿口咽部菌群分析及3株优势菌的拮抗作用

了解哮喘患儿呼吸道菌群多样性及其组成特征, 同时研究所分离的3株优势菌对流感嗜血杆菌的抑制作用, 探究哮喘与呼吸道菌群之间的关系。

采集沈阳市儿童医院呼吸内科2019年3月至2019年12月收治的21例4~12岁急性发作期哮喘患儿咽拭标本, 并同时采集23例同龄健康儿童的咽拭标本作为对照, 对呼吸道菌群进行分离培养、纯化和16S rRNA鉴定。采用牛津杯法检测健康儿童口咽部分离的3株优势菌对流感嗜血杆菌的拮抗作用。

哮喘和健康儿童呼吸道培养出的需氧菌(t=2.143, P=0.038)和厌氧菌(t=3.270, P=0.002)的密度差异有统计学意义。哮喘患儿咽部需氧菌以肺炎链球菌和流感嗜血杆菌为主, 厌氧菌以韦荣球菌为主。健康儿童咽部需氧菌以缓症链球菌和口腔链球菌为主, 厌氧菌以干酪乳杆菌为主。健康儿童口咽部的3株优势菌对哮喘儿童口咽部流感嗜血杆菌的生长具有显著抑制作用。

与健康儿童相比, 哮喘患儿口咽部菌群发生紊乱, 且哮喘患儿口咽部需氧菌、厌氧菌密度显著增加。健康儿童口咽部的某些优势菌可能对哮喘致病菌的定植有一定的拮抗作用。

     

347例SARI病例15种常见呼吸道病原特征分析

了解新疆维吾尔自治区人民医院住院严重急性呼吸道感染(Severe acute respiratory infection,SARI)病例呼吸道病原的构成及主要病原的流行规律,为SARI的防控提供线索和依据。应用多重PCR方法对2015年8月至2016年7月期间在新疆维吾尔自治区人民医院儿科、呼吸科、急诊科住院,且符合SARI病例定义的每周二、周四、周六新入院的患者进行检测。347份标本中检出14种呼吸道病原,未检测出衣原体,检出病毒阳性标本144份,阳性率为41.50%,检出前4位的病毒依次是,流感病毒72份、鼻病毒18份、呼吸道合胞病毒15份、偏肺病毒和副流感病毒各13份,阳性率分别为为20.75%,5.19%,4.32%,3.75%,3.75%,检出细菌阳性标本数为155份,阳性率为44.67%,其中肺炎链球菌阳性108份、流感嗜血杆菌阳性62份,肺炎支原体阳性13份,阳性率分别为31.12%、17.87%、3.75%;在108份肺炎链球菌阳性标本中41份标本合并病毒感染。新疆维吾尔自治区人民医院SARI病例病原主要以流感病毒,肺炎链球菌和流感嗜血杆菌为主,各年龄组均有检出,检出病原阳性高峰为冬春季;5岁及以下标本中检出腺病毒和百日咳杆菌会增加收住ICU的风险。     

跨膜蛋白CD82在流感病毒感染初期的表达

了解细胞跨膜蛋白CD82在流感病毒感染初期的表达变化,分析CD82在流感病毒感染中的作用。

采用逆转录−聚合酶链式反应（RT-PCR）方法对流感病毒感染4 h内的HEP-2细胞中CD82蛋白mRNA表达量进行检测。

流感病毒感染HEP-2细胞后1 h−3 h细胞 CD82的mRNA表达量降低,并且随着流感病毒接种量增加CD82表达量降低持续时间延长。

流感病毒可以在转录水平调节宿主细胞CD82的表达。CD82在流感病毒感染初期表达下降,提示CD82可能在流感病毒与宿主细胞粘附和入侵过程中发挥作用。

     

肺炎链球菌相关溶血尿毒综合征1例

阐述儿童肺炎链球菌相关溶血尿毒综合征的临床表现、诊断及治疗方法。

回顾性分析1例儿童肺炎链球菌相关溶血尿毒综合征患儿的临床表现、实验室检验、影像学检查、治疗经过及随访结果, 并以“肺炎链球菌相关溶血尿毒综合征”“Streptococcus pneumoniae-associated hemolytic-uremic syndrome”作为关键词检索国内外文献并进行复习。

患儿为男性, 3岁零5个月, 以发热、咳嗽起病, 有肺炎合并脓胸、胸腔积液, 胸腔积液行肺炎链球菌抗原检测为阳性, 胸腔积液行第二代测序结果为肺炎链球菌, 行血浆置换治疗病情好转, 3 d内血小板恢复, 血尿素氮及肌酐水平在8 d内恢复正常。随访3个月, 病情稳定, 无肾脏损害表现。

儿童重症肺炎合并胸腔积液患者当出现急性溶血性贫血、急性肾衰竭、血小板下降等表现时, 应考虑到肺炎链球菌相关溶血尿毒综合征的可能, 一旦确诊, 应及时采用血浆置换治疗, 效果显著, 预后良好。

     

呼吸窘迫综合征新生儿肠道菌群的改变

探究呼吸窘迫综合征新生儿肠道菌群的改变,为该类患儿的治疗提供参考。

选取我院2020年4月至2022年4月收治的83例呼吸窘迫综合征新生儿作为试验组,另选我院同期健康新生儿83例作为对照组,收集两组对象粪便标本。对比两组对象肠道菌群的变化情况。

与对照组相比,试验组患儿肠道菌群Chaol指数和Shannon指数显著降低,Ace指数显著升高,差异均有统计学意义（均P＜0.05）。两组对象肠道厚壁菌门、变形菌门、链球菌属相对丰度对比差异均有统计学意义（均P＜0.05）。

呼吸窘迫综合征新生儿肠道菌群改变较大。

     

2015-2020年大连市流感病毒分离鉴定情况分析

对2015-2020年大连市流感病毒分离鉴定情况进行对比分析, 为大连市流感防控工作提供参考。

采集大连市2家国家级流感监测哨点医院的流感样病例咽拭子样本, 用MDCK细胞和鸡胚分别进行病毒分离培养, 并采用HA试验和HI试验对分离的病毒滴度和型别进行鉴定。

2015-2020年共分离培养流感病毒核酸检测阳性的咽拭子1 055份, 其中MDCK细胞分离出流感病毒501株, 鸡胚分离出流感病毒72株, 总体病毒分离率54.31%。MDCK细胞分离出A(H1N1)、A(H3N2)、B(Victoria)和B(Yamagata)型病毒, 鸡胚对A(H3N2)型病毒不敏感, 但可以分离出A(H1N1)、B(Victoria)和B(Yamagata)型病毒。每年的优势毒株虽不同, 但分离流感病毒的月份均在流行季内, 与北方流行形势一致。

MDCK细胞与鸡胚的流感病毒分离率不同。大连市每年流感流行的优势株和流行程度虽不同, 但流行程度处于相对平稳状态。

     

妊娠妇女阴道微生态和B族链球菌与胎膜早破及母婴结局的相关性

探讨妊娠妇女阴道微生态状况和B族链球菌（GBS）感染与妊娠晚期胎膜早破及母婴结局的相关性。

回顾性收集2021年1月至2022年12月我院114例临床确诊足月胎膜早破妊娠妇女为研究对象（胎膜早破组）,随机选取同期分娩的129例健康妊娠妇女为对照组。收集两组对象临床资料,比较两组对象阴道微生态变化、GBS感染及不良母婴结局发生情况。

两组妊娠妇女阴道假丝酵母菌菌体及孢子检出情况比较差异均无统计学意义（均P＞0.05）。胎膜早破组患者阴道pH≥4.5、细菌性阴道病、需氧菌性阴道炎的发生率及微生态失衡率高于对照组（均P＜0.05）。胎膜早破组妊娠妇女绒毛膜羊膜炎、产褥感染、胎儿窘迫及新生儿肺炎等不良母婴结局发生率高于对照组（均P＜0.05）。单因素分析结果显示,阴道pH≥4.5、有GBS感染、阴道微生态失调与不良母婴结局有关（均P＜0.05）。

妊娠晚期阴道微生态失衡、GBS感染与妊娠晚期胎膜早破的发生相关,同时会增加不良母婴结局的发生率。加强相关危险因素的干预可降低妊娠晚期女性胎膜早破发生率,改善不良母婴结局。

     

支气管哮喘患者呼吸道菌群及FeNO、Th/Treg细胞水平变化

探究支气管哮喘患者呼吸道菌群及呼出气一氧化氮(FeNO)、Th17细胞与调节性T细胞(Treg)水平变化。

选取2017年5月至2019年8月我院呼吸内科收治的60例支气管哮喘患者为观察组, 选择同期35例健康者作为对照组。观察两组对象呼吸道菌群, FeNO、Th17细胞、Treg细胞, T细胞亚群及免疫球蛋白水平。

观察组患者共分离出87株细菌, 其中奈瑟菌检出率最高, 其次为肺炎链球菌、甲型链球菌、表皮葡萄球菌、韦荣球菌; 对照组对象共分离出35株细菌, 其中甲型链球菌检出率最高, 其次为表皮葡萄球菌、奈瑟菌、韦荣球菌、消化球菌。观察组患者甲型链球菌占比低于对照组(χ²=4.554, P=0.032), 其余菌群比较差异无统计学意义(均P > 0.05)。观察组患者FeNO、Th17细胞、Treg细胞水平及Th17/Treg均高于对照组, 差异有统计学意义(均P < 0.05)。观察组患者CD4⁺细胞、CD4⁺/CD8⁺低于对照组, 差异有统计学意义(均P < 0.05);而两组对象CD3⁺、CD8⁺细胞水平比较差异无统计学意义(均P > 0.05)。观察组患者免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)水平与对照组比较差异无统计学意义(均P > 0.05)。

支气管哮喘患者呼吸道检出率较高的菌群为奈瑟菌, 且FeNO、Th17/Treg水平均较高, 细胞免疫功能低下, 应及时进行治疗。

     

Respiratory viruses augment the adhesion of bacterial pathogens to respiratory epithelium in a viral species- and cell type-dependent manner

Secondary bacterial infections often complicate respiratory viral infections, but the mechanisms whereby viruses predispose to bacterial disease are not completely understood. We determined the effects of infection with respiratory syncytial virus (RSV), human parainfluenza virus 3 (HPIV-3), and influenza virus on the abilities of nontypeable Haemophilus influenzae and Streptococcus pneumoniae to adhere to respiratory epithelial cells and how these viruses alter the expression of known receptors for these bacteria. All viruses enhanced bacterial adhesion to primary and immortalized cell lines. RSV and HPIV-3 infection increased the expression of several known receptors for pathogenic bacteria by primary bronchial epithelial cells and A549 cells but not by primary small airway epithelial cells. Influenza virus infection did not alter receptor expression. Paramyxoviruses augmented bacterial adherence to primary bronchial epithelial cells and immortalized cell lines by up-regulating eukaryotic cell receptors for these pathogens, whereas this mechanism was less significant in primary small airway epithelial cells and in influenza virus infections. Respiratory viruses promote bacterial adhesion to respiratory epithelial cells, a process that may increase bacterial colonization and contribute to disease. These studies highlight the distinct responses of different cell types to viral infection and the need to consider this variation when interpreting studies of the interactions between respiratory cells and viral pathogens.     

Differential effect of prior influenza infection on alveolar macrophage phagocytosis of Staphylococcus aureus and Escherichia coli: involvement of interferon-gamma production

The influenza A virus is one of the main causes of respiratory infection. Although influenza virus infection alone can result in pneumonia, secondary bacterial infection combined with the virus is the major cause of morbidity and mortality. Interestingly, while influenza infection increases susceptibility to some bacteria, including Streptococcus pneumoniae, Staphylococcus aureus (S. aureus), and Haemophilus influenzae, other bacteria such as Escherichia coli (E. coli) and Klebsiella pneumoniae are not associated with influenza infection. The reason for this discrepancy is not known. In this study, it was found that prior influenza virus infection inhibits murine alveolar macrophage phagocytosis of S. aureus but not of E. coli. Here, the mechanism for this inhibition is elucidated: prior influenza virus infection strongly increases interferon gamma (IFN-γ) production. Furthermore, it was shown that IFN-γ differentially affects alveolar macrophage phagocytosis of S. aureus and E. coli. The findings of the present study explain how influenza virus infection increases susceptibility to some bacteria, such as S. aureus, but not others, and provides evidence that IFN-γ might be a promising target for protecting the human population from secondary bacterial infection by influenza.     

社区获得性肺炎非典型病原体分布及其流行特征

目的 了解社区获得性肺炎(CAP)非典型病原体感染的分布情况及其流行特征.方法 收集确诊为社区获得性肺炎患者278例,间接免疫荧光法(IFA)检测人血清中呼吸道9种主要的非典型性病原体的IgM抗体.结果 病原体检测阳性者150例,总阳性率54.O％.单一病原体感染中,肺炎支原体(MP) 125例(45.0％)、呼吸道合胞病毒( RSV) 27例(9.7％)、腺病毒22例(7.9％)、副流感病毒1、2和3型19例(6.8％)、乙型流感病毒16例(5.8％)、嗜肺军团菌血清1型13例(4.7％)、肺炎衣原体2例(0.7％)和甲型流感病毒1例(0.4％).混合感染共63例(22.7％),其中61例(21.9％)为MP与其他病原体的混合感染,病毒感染以RSV最常见,共27例(9.7％).CAP患者患有基础疾病共139例(50％),其余为无基础疾病者.基础疾病中以循环疾病和呼吸疾病最常见,各占总CAP患者的15,1％和13.0％.所有受检者MP阳性率最高,达45％,其中未成年组3～18岁中MP阳性率高达60.2％,而成人组18 ～50岁中MP阳性率高达81.8％.CAP春季病原体阳性检出率为46.9％,冬季病原体阳性检出率为63.8％(x2=7.752,P＜0.05).结论 非典型性病原体(特别是MP)感染在CAP患者中比例较大,其流行与分布跟病原体种类、基础疾病、年龄、季节等有一定的关系.     

儿童肺炎肺实变住院患儿支气管肺泡灌洗液病原分析

本研究分析肺炎肺实变患儿支气管肺泡灌洗液病原谱构成,旨在为临床经验性抗感染治疗提供指导。收集2019年1月-2020年1月复旦大学附属儿科医院纤维支气管镜室诊治的住院肺炎病例临床资料,其中肺实变的诊断基于影像学证据,依托国家儿童医学中心病原学检测平台,并参考感染传染科医生解读,本研究对肺炎伴肺实变患儿支气管肺泡灌洗液标本的病原学检测结果进行回顾性分析。结果显示,286例肺炎患儿的286份支气管肺泡灌洗液标本被纳入研究,平均年龄5.5(5.8±3.1)岁,其中195例(68.2%)存在肺炎伴肺实变。总病原体检出率为76.6%(219/286),肺实变和无肺实变肺炎患儿病原体检出率分别为77.9%(152/195)和73.6%(67/91),差异无统计学意义;检出的前5种病原体均为肺炎支原体、腺病毒、鼻病毒、呼吸道合胞病毒和副流感病毒3型。5周岁及以上患儿肺炎支原体检出率达最高77.0%(127/165),肺实变病例和无肺实变病例肺炎支原体检出率分别为67.2%(131/195)和61.5%(56/91),差异无统计学意义。本研究结果提示,肺炎支原体、腺病毒、鼻病毒、呼吸道合胞病毒和副流感病毒3型是导致本研究目标人群患病的主要病原体;病原体检出率高低与是否肺实变无关。     

Upper respiratory tract microbial communities, acute otitis media pathogens, and antibiotic use in healthy and sick children

The composition of the upper respiratory tract microbial community may influence the risk for colonization by the acute otitis media (AOM) pathogens Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. We used culture-independent methods to describe upper respiratory tract microbial communities in healthy children and children with upper respiratory tract infection with and without concurrent AOM. Nasal swabs and data were collected in a cross-sectional study of 240 children between 6 months and 3 years of age. Swabs were cultured for S. pneumoniae, and real-time PCR was used to identify S. pneumoniae, H. influenzae, and M. catarrhalis. The V1-V2 16S rRNA gene regions were sequenced using 454 pyrosequencing. Microbial communities were described using a taxon-based approach. Colonization by S. pneumoniae, H. influenzae, and M. catarrhalis was associated with lower levels of diversity in upper respiratory tract flora. We identified commensal taxa that were negatively associated with colonization by each AOM bacterial pathogen and with AOM. The balance of these relationships differed according to the colonizing AOM pathogen and history of antibiotic use. Children with antibiotic use in the past 6 months and a greater abundance of taxa, including Lactococcus and Propionibacterium, were less likely to have AOM than healthy children (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.25 to 0.85). Children with no antibiotic use in the past 6 months, a low abundance of Streptococcus and Haemophilus, and a high abundance of Corynebacterium and Dolosigranulum were less likely to have AOM (OR, 0.51; 95% CI, 0.31 to 0.83). An increased understanding of polymicrobial interactions will facilitate the development of effective AOM prevention strategies.     

Acute viral infections of upper respiratory tract in elderly people living in the community: comparative,prospective, population based study of disease burden.

OBJECTIVE: To evaluate the disease burden of upper respiratory infections in elderly people living at home. DESIGN: Prospective surveillance of elderly people. INTERVENTION: None. SETTING: Leicestershire, England SUBJECTS: 533 subjects 60 to 90 years of age. MAIN OUTCOME MEASURES: Pathogens, symptoms, restriction of activity, duration of illness, medical consultations, interval between onset of illness and medical consultation, antibiotic use, admission to hospital, and death. RESULTS: 231 pathogens were identified for 211 (43%) of 497 episodes for which diagnostic specimens were available: 121 (52%) were rhinoviruses, 59 (26%) were coronaviruses, 22 (9.5%) were influenza A or B, 17 (7%) were respiratory syncytial virus, 7 (3%) were parainfluenza viruses, and 3 (1%) were Chlamydia species; an adenovirus and Mycoplasma pneumoniae caused one infection each. Infections occurred at a rate of 1.2 episodes per person per annum (95% confidence interval 1.0 to 1.7; range 0-10) and were clinically indistinguishable. Lower respiratory tract symptoms complicated 65% of upper respiratory infections and increased the medical consultation rate 2.4-fold (chi 2 test P < 0.001). The median interval between onset of illness and medical consultation was 3 days for influenza and 5 days for other infections. Rhinoviruses caused the greatest disease burden overall followed by episodes of unknown aetiology, coronaviruses, influenza A and B, and respiratory syncytial virus. CONCLUSIONS: Respiratory viruses cause substantial morbidity in elderly people. Although respiratory syncytial virus and influenza cause considerable individual morbidity, the burden of disease from rhinovirus infections and infections of unknown aetiology seems greater overall. The interval between onset of illness and consultation together with diagnostic difficulties raises concern regarding the role of antiviral drugs in treating influenza.     

Prevention of acute otitis media using currently available vaccines

Acute otitis media (AOM) is common in infants and children. Although approximately two-thirds of cases are due to bacteria, almost all of the episodes are preceded by upper respiratory viral infection. Several viruses, among which respiratory syncytial virus is the most common, are involved in the determination of AOM. However, a significant number of AOM cases are associated with influenza infection, and influenza viruses are among the most frequently found respiratory viruses in the middle ear fluid during an acute episode of AOM. Consequently, influenza vaccination may have a favorable impact on the incidence and course of AOM. Moreover, as Streptococcus pneumoniae is one of the leading AOM bacterial pathogens and it is well known that influenza virus infection predisposes to pneumococcal infection, there is a further reason to suggest the use of influenza vaccine to reduce the risk of AOM. On the other hand, the administration of pneumococcal conjugate vaccine is considered per se a possible means of reducing the incidence of the disease. However, although a number of studies have measured the impact of both vaccines on AOM, it is still not known whether (and to what extent) they are really effective, nor what impact the more recently licensed vaccines may have. The aim of this review is to examine the clinical impact of vaccinations on AOM.     

Nosopharyngeal microflora in ambulatory treated children and adults with upper respiratory tract infections

Upper respiratory tract consists resident and transient bacterial microflora, which in appropriate condition can cause infection. Bacteriological study was performed among 201 patients with upper respiratory tract infections treated in ambulatory. From nasal and pharyngeal swabs Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, and Streptococci group A, B, C, G were isolated. Antibiotic susceptibility testing of isolated strains was performed using CLSI criteria. All isolated strains of streptococci were susceptible to penicillin; some of them demonstrated resistance to macrolides and lincosamides. Few isolated strains of H. influenzae demonstrated resistance to penicillin and cotrimoxazole. Azitromycin resistant strains were not detected. All isolated strains of M. catarrhalis were beta-lactamase positive and demonstrated resistance to penicillin. Strains of methicillin sensitive S. aureus (MSSA) were isolated most frequently from pharyngeal swabs (35.4%) and S. pneumoniae (33.3)--from nasal swabs.     

241 例儿童社区获得性肺炎支原体感染的临床分析

目的：总结2011-2012 年黄岛地区儿童社区获得性肺炎(CAP)患儿中支原体的感染情况,以指导临床诊断和治疗。方法：选取 2011-2012 年间因CAP住院的患儿241 例,所有CAP 患儿均于住院第2 天采集空腹血行9 项呼吸道感染病原体IgM检查,包括 肺炎支原体、嗜肺军团菌、Q热立克次体、肺炎衣原体、腺病毒、呼吸道合胞病毒、甲型流感病毒、乙型流感病毒、副流感病毒。结 果：241 例社区获得性肺炎患儿中支原体感染阳性74 例(30.7%),其中132例男性CAP患儿中支原体感染38 例(28.8%),109 例女 性CAP 患儿中支原体感染36 例;＞3 岁患儿的感染率为41.2%,1-3 岁患儿感染率26.2%,＜1 岁婴幼儿感染率为5.4%;2011 年 CAP患儿支原体感染率为19.4%,而2012 年为34.6%;74 例支原体阳性患儿合并其他感染者6 例。结论：黄岛地区儿童社区获得 性肺炎中支原体感染占重要地位,且有升高趋势,应重视婴幼儿支原体感染及难治性支原体肺炎的诊治。