轮状病毒病毒血症与肠道外脏器损伤的研究

Viraemia and extraintestinal involvement after rotavirus infection

目的:研究杭州地区急性轮状病毒肠炎患儿中病毒血症的发生情况,及其与肠道感染的严重程度、肠道外脏器损伤的关系。方法:对2002年10月-2003年3月在本院住院治疗的83例急性轮状病毒肠炎患儿进行前瞻性研究,取患儿急性期血及粪便,用套式-逆转录PCR方法检测轮状病毒RNA(RV-RNA)。将血RV-RNA阳性病例设为观察组,阴性病例设为对照组。比较两组患儿肠道感染的严重程度及肠道外脏器损伤的情况。结果:83例患儿中大便RV-RNA阳性82例,血RV-RNA阳性16例(19.3%)。观察组(16例)与对照组(67例)相比在发热、腹泻、水电解质酸碱平衡紊乱程度及心肌损害发生率无显著性差异(P>0.05)。而肝功能损害、皮疹、下呼吸道感染、中枢神经系统损害发生率明显高于对照组(P<0.05)。结论:轮状病毒肠炎患儿病程中存在病毒血症,其可能是轮状病毒引起肠道外脏器损害的重要机制之一。

Objective： To study the incidence of viraemia and extraintestinal organ damage in children with acute rotavirus （RV） gastroenteritis. Methods： Eighty-three children with acute rotavirus gastroenteritis were hospitalized from October 2002 to March 2003, whose blood and fecal samples were obtained on admission. Rotavirus RNA （encoding the VP7 outer capsid protein） were detected in blood and fecal samples by nest reverse transcription-polymerase chain reaction （RT-PCR）. According to the result of blood RV-RNA,the patients were divided into RV-RNA positive group and RV-RNA negative group. The differences between these two groups in the severity of gastroenteritis and extraintestinal organ damage were analyzed. Results： Eighty-two of 83 stool samples from the children with rotavirus infection were positive for rotavirus RNA. Sixteen of 83 blood samples were positive for rotavirus RNA with a positive rate of 19.3%. The identical from p blood RV-RNA nucleotide sequence of cloned cDNAs, resembling part of the VP7 gene, was aired blood and fecal samples. There were no significant differences between positive group and blood RV-RNA negative group in the rate and degree of fever,diarrhea,dehydration,metabolic acidosis,hypokalemia and myocardial damage the incidences of liver damage, rash, lower respiratory tract infection and t system involvement in the blood RV-RNA positive group were significantly h （P〉0. 05） ; while he central nervous igher than those in the blood RV-RNA negative group（P〈0.05）. Conclusion： Viraemia is present in the children with acute rotavirus gastroenteritis. Viraemia might be an important mechanism by which rotavirus spread to the extraintestinal sites resulting in organs damage.