儿童重症社区获得性肺炎病毒学检测和危险因素分析

Viral etiology and risk factors for severe community-acquired pneumonia in children

摘要:

目的：了解儿童重症社区获得性肺炎病毒病原谱，探讨儿童重症社区获得性肺炎的危险因素。方法：收集2007年9月至2008年8月1096例社区获得性肺炎患儿的气道抽吸物标本，其中重症社区获得性肺炎100例。采用RT-PCR、PCR或巢式PCR方法对呼吸道病毒进行核酸检测。应用logistic回归法对患儿的临床相关资料进行单因素和多因素分析，以调查重症社区获得性肺炎的危险因素。结果：100例儿童重症社区获得性肺炎标本中，病毒总检出例数为82例(82％)，其中RSV检出率最高（37％），其次为HBoV(25％)和HRV (18％)。2种及2种以上病毒协同感染32例（32%）。Logistic回归分析显示，合并基础疾病及RSV感染为儿童重症社区获得性肺炎发病的危险因素（分别OR=6.623，P<0.01；OR=1.672，P<0.05），月龄为保护因素（OR=0.475，P<0.01）。结论：RSV是儿童重症社区获得性肺炎最常见病毒病原；合并基础疾病及RSV感染是儿童重症社区获得性肺炎发病的危险因素，月龄为保护因素。

Abstract:

OBJECTIVE: To study the virus spectrum of severe community-acquired pneumonia (CAP) and risk factors for the disease in children. METHODS: Respiratory secretion specimens were collected from 1096 children hospitalized with CAP from June 2007 to November 2008, including 100 cases of severe CAP. Respiratory viruses were detected by PCR, nest-PCR or RT-PCR. Clinical data on the children were analyzed by univariate and multivariate logistic regression analysis for examining risk factors for severe CAP. RESULTS: Viral pathogens were isolated from 82 (82%) of the 100 cases with severe CAP. RSV was the most common (37%), followed by HBoV (25%) and HRV (18%). Mixed infection was noted in 32 cases (32%). The presence of underlying diseases (OR=6.623, P<0.01) and RSV infection (OR=1.672, P<0.05) were risk factors for severe CAP in children, while age was a protective factor (OR=0.475, P<0.01). CONCLUSIONS: RSV is the most frequent viral pathogen in children with severe CAP. The presence of underlying diseases and RSV infection may be risk factors for severe CAP, while age is a protective factor.