急性下呼吸道感染儿童肠道病毒感染的状况

Status of enterovirus infection in children with acute lower respiratory tract infection

摘要:

目的：了解急性下呼吸道感染(ALRTI) 患儿肠道病毒(EV)的感染状况和临床特征。方法：抽取2007年9月至2008年4月因ALRTI在湖南省人民医院儿科医学中心住院的患儿的鼻咽抽吸物单数号样本404份，应用EV5′端非编码区(5′-NCR)保守序列设计引物，采用巢式逆转录RT-PCR法检测标本中EV感染状况。结果：404份ALRTI标本中，检出EV19例（4.7%），大部分患儿年龄在3岁以下（95%），男女EV检出阳性率差异无统计学意义。EV阳性患儿临床诊断为支气管肺炎者13例（68%）、毛细支气管炎者6例（32%），90%患儿有发热症状，84%有咳嗽，63%有气喘，63%有合并症，其中主要为腹泻（6例）、粒细胞减少症（4例）和急性呼吸窘迫综合征（2例）。EV阳性患儿白细胞异常的发生率为26%，一半以上存在肝功能异常，少数有心肌受累。结论：EV是儿童ALRTI不可忽视的病原之一，应密切关注EV感染的流行病学状况和临床特点，并定期测定患儿血常规、肝功能和心肌酶，努力改善其预后。

Abstract:

OBJECTIVE: To investigate the status of enterovirus (EV) infection in children with acute lower respiratory tract infection (ALRTI). METHODS: A total of 404 samples (with odd numbers) of nasopharyngeal aspirates were collected from the children who were hospitalized in the Children′s Medical Center, Hunan Provincial People′s Hospital due to ALRTI between September 2007 and April 2008. The conserved sequence in the 5′-noncoding region of EV was used to design the primer, and nested RT-PCR was performed to detect EV in the samples. RESULTS: Of the 404 samples, 19 (4.7%) were EV-positive, and mostly taken from children under 3 years of age (95%); there was no significant difference in the detection rate between male and female children. Of the EV-positive children, 13 (68%) were clinically diagnosed with bronchial pneumonia, and 6 (32%) with bronchiolitis; 90% of them showed symptoms of fever, 84% had a cough, 63% had asthma, and 63% had complications mainly including diarrhea (6 cases), granulocytopenia (4 cases), and acute respiratory distress syndrome (2 cases). In addition, 26% of the EV-positive children had leukocyte disorder, more than half had liver dysfunction, and a few had myocardial involvement. CONCLUSIONS: EV is a pathogen that should not be neglected in children with ALRTI. For these children, close attention should be paid to the epidemiological status and clinical features of EV infection, and blood routine examination, liver function test and myocardial enzyme assay should be carried out periodically to improve prognosis.