北京市通州地区小儿急性呼吸道感染病原学分析

Etiological analysis of pediatric acute respiratory infection in Tongzhou District of Beijing

目的探讨北京市通州地区小儿急性呼吸道感染的常见病原体及其发病特点,为急性呼吸道感染患儿的防治提供临床依据。方法选取2015年9月1日~2017年8月31日首都医科大学附属北京潞河医院儿童中心的急性呼吸道感染患儿,取静脉血2 mL,采用间接免疫荧光法检测8种常见呼吸道病原体IgM抗体,包括呼吸道合胞病毒(RSV)、腺病毒(ADV)、甲型流感病毒(INFA)、乙型流感病毒(INFB)、副流感病毒(PIVs)、肺炎支原体(MP)、肺炎衣原体(CPn)及嗜肺军团菌(LPS)。分析不同病原体抗体阳性率及其发病特点。结果共入选1319例患儿,检出阳性标本962份,占72.93%。其中MP阳性检出最多,占61.85%,其次是INFB,其他依次为CPn、RSV、INFA、PIVs和ADV。在检出的阳性标本中,单病原感染者占58.63%,双病原感染(即双重感染)的38.36%,三种及以上病原同时感染(即多重感染)者占3.01%。双重感染最常见的病原体组合为MP+INFB。病原体阳性检出率具有一定的季节性,MP感染主要集中在9、10、11月份,INFB感染从9月份开始增多,11、12月份达到高峰,之后逐渐下降,到3、4月份再次出现1个小高峰(P<0.05)。不同年龄易感的病原体有明显不同(P<0.05),其中单病原感染MP或INFB的高峰年龄为3~6岁,而双重感染MP+INFB阳性率最高的年龄段为11个月~3岁。所有患儿中病原体抗体阳性检出率女性与男性相似(P>0.05)。以MP+INFB双重感染所致肺炎为主要住院原因,占25.83%,其次MP感染占25.39%,再次为INFB感染占13.84%。合并症以心肌损害最为多见,占21.45%。结论本区域呼吸道感染病原体以MP和INFB为主,感染类型主要是单项感染和双重感染(MP+INFB),秋季开始增多,冬季高发,春季出现小高峰。单项感染高发年龄为3~6岁,双重感染高发年龄为11个月~3岁。

Objective To detect the common pathogens of acute respiratory tract infection （ARI） of children in Tongzhou District of Beijing, so as to provide clinical evidences for the prevention and treatment of children＇s ARI. Methods Children with ARI were enrolled who hospitalized in the Children＇s Center of Beijing Luhe Hospital, affiliated to Capital Medical University from September 1st, 2015 to Augest 31st, 2017. 2 mL of venous blood was collected, and 8 kinds of common respiratory pathogens IgM antibody were detected by indirect immunofluoreseence, including RSV, ADV, INFA, INFB and PIVs. Then etiology tendency was analyzed. Results A total of 1319 children were enrolled and 962 positive samples were detected, accounting for 72.93%. Among them, MP positive detection was the most, accounting for 61.85%, followed by INFB, CPn, RSV, INFA, PIVs and ADV in turn. Among the positive samples, single pathogenic infection accounted for 58.63%, two pathogenic infection （double infection） accounted for 38.36% and three or more pathogenic infection （multiple infection） accounted for 3.01%. The most common pathogens combination of double infection was MP and INFB. Pathogens infection showed obvious seasonal changes. MP infection mainly concentrated in September to November. INFB infection increased from September, reached a peak in November and December, then decreased gradually, and reached a peak again in the following March （P 〈 0.05）. The susceptible ages of different pathogens were significantly different （P 〈 0.05）. The peak age of single pathogen infection （MP or INFB） was 3 years old, while the age of the highest positive rate of double infection （MP and INFB） was 11 months-3 years old. Positive detection rate of pathogens was similar in female and male （P 〉 0.05）. Pneumonia was the main cause of hospitalization. Among them, double infection （MP and INFB） was the main cause, accounting for 25.83%, followed by MP infection and INFB infection, respectively accounted for 25.39% and 13.84%. Myocardial damage was the most common complication, accounting for 21.45%. Conclusion The main pathogens of respiratory tract infection in this region are MP and INFB. The main types of infection are single infection and double infection （MP＋INFB）. The number of cases increase from the fall, peak in winter and reach a small peak in the following spring again. The single infection mostly occurs in 3-6 years old and double infection mainly occurs in 11 months-3 years old.