1165例急性下呼吸道感染住院儿童的病毒病原学分析

Viral etiology of 1165 hospitalized children with acute lower respiratory tract infection

摘要:

目的：了解长沙地区急性下呼吸道感染(ALRTI) 住院儿童中常见呼吸道病毒的流行特点，为本地区儿童ALRTI的防治提供依据。方法：收集2007年9月至2008年8月诊断为ALRTI的住院患儿鼻咽抽吸物标本1165份，采用RT-PCR方法检测呼吸道合胞病毒(RSV)、鼻病毒(HRV)、流感病毒A(IFVA)、流感病毒B(IFVB)、副流感病毒1~3(PIV1~3)、偏肺病毒(hMPV)、冠状病毒NL63(HCoV-NL63)及冠状病毒HKU1(HCoV-HKU1)；PCR方法检测腺病毒(ADV)、博卡病毒(HBoV)；巢式PCR方法检测多瘤病毒WU(WUPyV）和多瘤病毒KI(KIPyV)。并对阳性标本进行基因测序以证实。结果：1165份标本中有871份检出了病毒，总检出率74.76%，其中RSV最为常见，检出率为27.03%，其次为HRV（17.33%）、PIV3（13.73%）及新发现病毒HBoV(8.67%)和hMPV(6.52%)。病毒总检出率在男女之间差异无统计学意义，但男性PIV3、hMPV和HBoV的阳性检出率高于女性。病毒阳性检出率在各年龄组之间差异有统计学意义（χ2=10.934，P=0.027），以6个月至1岁以内年龄组检出率最高。病毒总检出率在四季分布差异有统计学意义（χ2=12.307，P=0.006），以冬季检出率最高。结论：病毒病原在长沙地区儿童ALRTI中占重要地位，其中RSV、HRV及PIV3是主要病毒病原，近年新发现的HBoV和hMPV也占较高比例；病毒检出率以6个月至1岁以内年龄组最高；冬季病毒总检出率高于其他季节。

Abstract:

OBJECTIVE: To explore the viral etiology of acute low respiratory tract infection (ALRTI) among hospitalized children in Changsha of Hunan Province of China. METHODS: Nasopharyngeal aspirates were collected from 1165 hospitalized children with ALRTI in Changsha from September 2007 to August 2008. Respiratory syncytin virus (RSV), human rhinovirus (HRV), influenza virus A (IFVA), influenza virus B (IFVB), parainfluenza 1-3 (PIV 1-3), human metapneumovirus (hMPV), human coronaviruses NL63 (HCoV-NL63), and human coronaviruses HKU1 (HCoVHKU1) were detected by reverse transcription polymerase chain reaction (RT-PCR). Adenovirus (ADV) and human bocavirus (HBoV) were detected by standard polymerase chain reaction (PCR). WU polyomaviruses (WUPyV) and KI polyomaviruses(KIPyV) were detected by nested PCR. The positive samples further underwent genetic sequencing. RESULTS: Among the 1165 nasopharyngeal aspirates, viruses were detected in 871 samples (74.76%), among which RSV (27.03%) was the most common virus, followed by HRV (17.33%), PIV3(13.73%), HBoV (8.67%) and hMPV (6.52%). The overall positive rate of viral detection showed no significant differences between males and females (χ2=2.241, P=0.134), whereas the positive rates of PIV3, hMPV, and HBoV in males were higher than in females. The positive rate of viral detection showed significant differences among different age groups (χ2=10.934, P=0.027), and the highest positive rate was noted in the age group of 6 months to 1 year. Furthermore, the overall positive rate of viral detection showed a significant difference in term of seasonal distribution, with a peak prevalence in winter. CONCLUSIONS: Virues predominate in the etiology of pediatric ALRTI in Changsha, and RSV, HRV and PIV3 are the main viruses for ALRTI. HBoV and hMPV have become increasingly important. Viral infection-associated ALRTI shows a prevail in the age group of 6 months to 1 year as well as in winter.