6岁以下儿童急性下呼吸道感染的病毒病原及临床研究

A viral etiological and clinical investigation into acute lower respiratory tract infection in children under 6 years old

目的 了解北京地区 6岁以下儿童中急性下呼吸道感染 (ALRI)患儿的病毒感染状况 ;探讨人类偏肺病毒 (hMPV)感染在儿童ALRI中的作用及所致支气管肺炎的临床特征。方法 (1)采集 2 0 0 1年 2月至 2 0 0 3年 3月就诊于首都儿科研究所 4 4 6例年龄 1个月至 5岁的ALRI住院患儿的鼻咽分泌物 ,同时应用间接免疫荧光 (IFA)及病毒分离方法进行人类呼吸道合胞病毒 (hRSV)、流感病毒 (甲、乙型 )、副流感病毒 (Ⅰ、Ⅱ、Ⅲ型 )及腺病毒等 7种常见呼吸道病毒的病原检测。 (2 )采用逆转录聚合酶链反应 (RT PCR)方法对 2 0 0 2年 11月至 2 0 0 3年 3月住我院内科的ALRI患儿中经 7种呼吸道常见病毒病原检测阴性的 2 16份鼻咽洗液 ,进行了hMPV基因检测 ,并分析hMPV感染患儿的临床资料。结果 (1) 4 4 6例患儿中 7种常见呼吸道病毒总阳性例数为 2 0 9例 (46 86 % ) ,hRSV阳性者最多为 16 3例 (36 5 5 % )。 (2 )在 2 16份上述 7种呼吸道病原检测阴性的标本中 6 9份测到hMPV阳性扩增产物 (31 9% ) ,占同期送检标本的 19 17%。结论 (1)hRSV是北京地区冬春季节婴幼儿ALRI的主要病原。 (2 )2 0 0 2年 11月至 2 0 0 3年 3月我院ALRI住院患儿中有 19

Objective To expand our understanding of viral etiology of acute lower respiratory infection (ALRI) in children under 6 years old in Beijing and investigate the association of human metapneumovirus(hMPV) infection with ALRI and characteristics of pneumonia caused by this new respiratory virus.Methods The nasopharyngeal samples from 446 children less than 6 years old admitted to the Respiratory Department because of ALRI were investigated for human respiratory syncytial virus (hRSV),influenza A and B viruses,parainfluenza viruses type 1,2,3 and adenovirus by employing both the indirect immunofluorescence assay(IFA) and the cell culture virus isolation over a two year period (February 2001 March 2003).63 samples collected during July 2002 November 2002 were examined for entervirus (EV) by employing RT PCR too.From November 2002 to March 2003,216 specimens which had firstly demonstrated as negative for the 7 kinds of conventional viruses(hRSV,influenza A and B viruses,parainfluenza viruses type 1,2,3,adenovirus ) were detected for hMPV gene fragments by reverse transcription polymerase chain reaction(RT PCR) and the clinical data of the patients with hMPV pneumonia diagnosed etiologically were analyzed.Results Examination for 7 kinds of conventional respiratory virus yielded a total of 209 positive results in 446 samples(46.86%),of which 36.55% were RSV.Screening for EV achieved 24 of 63 (38.10%) samples.Among 216 specimens detected for hMPV,64 showed the predicted 213 bp PCR products.Of these 64 patients,35% were diagnosed clinically as pneumonia and 21 % as bronchiolitis.Conclusion RSV is still the leading cause of ALRI in infants and young children during winter and spring in Beijing.EV may play an important role in ALRI in summer and fall.19.17% of infants hospitalized in our institute from November 2002 to February 2003 were caused by hMPV infection.