2019-2021年宁波地区儿童13种呼吸道非细菌性病原体检出情况分析

Analysis of non-bacterial respiratory pathogens in children in Ningbo City from 2019 to 2021

目的探讨2019—2021年宁波地区儿童呼吸道非细菌性病原体的分布特点。方法回顾性分析2019年7月至2021年12月期间宁波市妇女儿童医院儿科就诊的23733例呼吸道感染患儿,男性13509例(56.92%),女性10224例(43.08%),年龄范围为1 d至18岁。新生儿组(年龄<1个月)981例,婴儿组(1个月≤年龄<1岁)5880例,幼儿组(1岁≤年龄<3岁)6552例,学龄前组(3岁≤年龄<7岁)7638例,学龄组(7岁≤年龄≤18岁)2682例。通过基于毛细电泳的多重聚合酶链反应(polymerase chain reaction,PCR)检测13种呼吸道病原体,对结果采用SPSS 23.0软件进行统计学分析,计数资料以百分比表示,组间比较采用χ^(2)检验。结果23733例患儿中13330例呼吸道病原体检测阳性,总阳性率为56.17%。阳性率前3位分别为鼻病毒(human rhinovirus,HRV)24.05%(5707/23733)、呼吸道合胞病毒(human respiratory syncytial virus,HRSV)10.45%(2480/23733)和肺炎支原体(mycoplasma pneumoniae,Mp)7.03%(1668/23733)。病原体在男性患儿和女性患儿中的阳性率分别为57.47%(7763/13509)和54.45%(5567/10224),差异具有统计学意义(χ^(2)=21.488,P<0.001);在新生儿组、婴儿组、幼儿组、学龄前组、学龄组中的阳性率分别为31.80%(312/981)、54.71%(3217/5880)、63.23%(4143/6552)、59.83%(4570/7638)和40.57%(1088/2682),组间差异具有统计学意义(χ^(2)=681.225,P<0.001);单一感染率为47.43%(11256/23733),2种及以上病原体混合感染率为8.74%(2074/23733),其中以2种病原体混合感染多见。HRV、腺病毒(human adenovirus,HADV)、冠状病毒(human coronavirus,HCOV)、衣原体(chlamydia,Ch)全年散发,HRSV、偏肺病毒(human metapneumovirus,HMPV)、博卡病毒(human bocaviru,Boca)、副流感病毒(human parainfluenza virus,HPIV)在秋冬季高发;甲型流感病毒(influenza A virus,FluA)、乙型流感病毒(influenza B virus,FluB)、Mp在2020、2021年阳性率处于低位。相比于2019年同期,FluA、甲型流感病毒H1N1(2009)(influenza A H1N1 pdm09 virus,H1N1)、甲型流感病毒H3N2(influenza A H3N2 virus,H3N2)、FluB、HADV、Mp在2020年的阳性率显著下降(P<0.05),HPIV、HRV、HCOV、Ch则显著上升(P<0.05);相比于2020年,FluA、H1N1、H3N2、HPIV、HCOV、Mp、Ch在2021年的阳性率显著下降(P<0.05),Boca、HMPV、HRSV则显著上升(P<0.05)。结论2019—2021年宁波市儿童呼吸道非细菌性病原体检出以HRV和HRSV为主,呼吸道病原体阳性率在不同年龄阶段、季节和性别间存在一定差异。

Objective To investigate the distribution characteristics of respiratory non-bacterial pathogens in children in Ningbo from 2019 to 2021.Methods A retrospective analysis was performed on 23733 children with respiratory tract infection who visited the department of pediatrics of Ningbo Women and Children′s Hospital from July 2019 to December 2021.There were 13509 males(56.92%)and 10224 females(43.08%),with an age range of 1 day to 18 years old.There were 981 cases in the neonatal group(younger than 1 month old),5880 cases in the infant group(1 month to younger than 1 year old),6552 cases in the toddler group(1 to younger than 3 years old),7638 cases in the preschool group(3 to younger than 7 years old),and 2682 cases in the school-age group(7 to 18 years old).Thirteen respiratory pathogens were detected by multiple polymerase chain reaction(PCR)based on capillary electrophoresis,and SPSS 23.0 software was used for statistical analysis of the results,the count data were expressed as percentages,and theχ^(2) test was used for comparison between groups.Results Of the 23733 specimens,13330 were positive for respiratory pathogens,with a total positive rate of 56.17%.The positive rates of human rhinovirus(HRV)24.05%(5707/23733),human respiratory syncytial virus(HRSV)10.45%(2480/23733)and mycoplasma pneumoniae(Mp)7.03%(1668/23733)were in the first three.The positive rates of pathogens in the male and female children were 57.47%(7763/13509)and 54.45%(5567/10224),respectively,and the difference was statistically significant(χ^(2)=21.488,P<0.001).The positive rates in the neonatal group,infant group,toddler group,preschool group,and school-age group were 31.80%(312/981),54.71%(3217/5880),63.23%(4143/6552),59.83%(4570/7638),40.57%(1088/2682),respectively,and the difference among the groups was statistically significant(χ^(2)=681.225,P<0.001).The single infection rate was 47.43%(11256/23733),the mixed infection rate of two or more pathogens was 8.74%(2074/23733),most of which were mixed infections of two pathogens.HRV,HADV,HCOV,Ch disseminated in the whole year.HRSV,HMPV,Boca,HPIV occurred mostly in fall and winter.The positive rates of FluA,FluB,Mp were at a low level after the corona virus disease 2019(COVID-19)epidemic(2020 and 2021).The positive rates of FluA,H1N1,H3N2,FluB,HADV,Mp in 2020 were significantly lower than in 2019(P<0.05).The positive rates of HPIV,HRV,HCOV,Ch in 2020 were significantly higher than in 2019(P<0.05).The positive rates of FluA,H1N1,H3N2,HPIV,HCOV,Mp,Ch in 2021 were significantly lower than in 2020(P<0.05).The positive rates of Boca,HMPV,HRSV in 2021 were significantly higher than in 2020(P<0.05).Conclusion From 2019 to 2021,the main non-bacterial respiratory pathogens of children in Ningbo City were Mp and HRV,and the detection rates of respiratory pathogens varied among different ages,seasons and genders.