江门某医院儿童秋冬季腹泻中诺瓦克样病毒感染分子流行病学与临床特征研究

Molecular Epidemiology of Diarrhea among Children with Norwalk-Like Virus in A Hospital of Jiangmen in Autumn and Winter

目的了解江门市2005年秋冬季儿童腹泻中诺瓦克样病毒(NLVs)感染情况、病毒基因型别及主要临床表现。方法收集某医院临床诊断为病毒性腹泻患儿的粪便标本用RT-PCR方法检测NLVs,部分阳性标本PCR产物经纯化、测序后进行基因分型。患儿临床症状等情况进行问卷调查,并以NLVs与RV腹泻的主要临床表现进行了比较。结果在收集的324份标本中,RV检出率为55.56%(180/324),NLVs检出率为7.72%(25/324)。NLVs主要感染2岁以下的婴幼儿,占感染患儿的96%,其性别、月份检出率差别无统计学意义。9株NLVs经测序分析7株为GII-4型,2株为GII-3型。NLVs感染的临床症状主要有发烧11(44.0%),呕吐20(80.0%),脱水3(12.0%)和腹痛4(16.0%)等,其中呕吐、脱水发生率及治疗费用与RV感染者差别有统计学意义。结论江门市儿童NLVs感染存在着不同的基因型别感染,但NLVs感染患儿的临床症状要轻于RV。

Objective To explore the epidemiological and clinical characterization of Norwalk-like virus （NLVs） among children with non-bacterial diarrhea in Jiangmen Matemity ＆ Child Health Care Hospital in autumn and winter, and to determine the genotypes of the NLVs. Method Fecal specimens and questionnaires were collected from non-bacterial diarrhea children in Jiangmen Maternity ＆ Child Health Care Hospital from Oct. 2005 to Jan. 2006. Some amplicons obtained from NLVs-positive stools were purified and sequenced. Phylogenetic tree was created for strain characterization and determination of the predominant genotype of the NLVs. To assess the medical importance of NLVs infection, the clinical characteristics of children infected with NLVs were compared with those found in patients infected with rotavirus. Result 324 fecal specimens were collected from non-bacterial diarrhea children. 55.56% （180/324） was RV positive and 7.72%（25/324）was NLVs positive. NLVs detection was mainly distributed in children under 2 years old, but was similarity in every month of the season and of different sex. Among 9 sequenced strains, 7 are GⅡ-4 and 2 are GⅡ-3. From the 25 NLVs positive cases, 20 （80.0%） were associated with vomiting, 11 （44.0%） with fever, 3（12.0%） with dehydration and 4（16.0%） with abdominal pains. Vomiting rate. dehydration rate and therapy expense were significantly different between NLVs infected children and RV infected children. Conclusion NLVs is an important etiological agent of viral gastroenteritis and more than two genotypes is circulating among the children of Jiangmen Maternity ＆ Child Health Care Hospital. And NLVs diarrhea clinical severity was different from that of rotavirus.