北京地区2002—2006年急性呼吸道感染儿童中鼻病毒感染的研究

Study on the status of human rhinovirus infections in infants and young children with acute respiratory infections in Beijing,from 2002 to 2006

目的对北京地区急性呼吸道感染患儿的鼻病毒(HRV)感染状况进行分析,以初步了解近年来鼻病毒感染在儿科患者中的流行规律。方法收集2002年11月至2006年11月来自首都儿科研究所附属儿童医院门诊及病房急性呼吸道感染患儿标本共3292份,应用针对HRV14 5′端非编码区(5′-NCR)保守区基因序列设计的引物进行巢式PCR检测标本中HRV。结果3292份标本中HRV总阳性检出为507份,占本组检测标本的15.4%(507/3292),其中门诊患儿中阳性检出率为16.7%,住院患儿为14.5%;HRV阳性检出率在咽炎患儿中达到50.0%(8/16),在急性支气管炎的喘息性支气管炎患儿中为17.5%(14/80),其他如急性支气管肺炎、毛细支气管炎等患儿中也有较高的HRV阳性检出率;在以血液系统疾病等为第一诊断,合并有呼吸道病毒感染的患儿中HRV检测阳性率为26.4%(14/53)。HRV感染的季节性分布中,2003年的检出高峰在9月份,阳性检出率达32.6%;2004年检出率最高的是2月份(阳性检出率为24.2%),但与其他年度相比,阳性率略低;2005年的检出高峰在2月份,阳性检出率达35.3%;2006年的检出高峰在3月份,阳性检出率为31.3%。在HRV检测阳性的患儿中,年龄≤1岁的占44.8%,其次为～2岁(15.4%)、～3岁(12.4%)年龄组的患儿。结论HRV不仅可引起急性上呼吸道感染,在下呼吸道感染患儿中也有较高的感染率,在患其他疾病导致抵抗力低下时易于并发呼吸道鼻病毒感染。HRV感染存在于各年龄组并全年均可发生。随年龄增长,HRV阳性检出率逐渐降低。婴幼儿,尤其是1岁以下的婴儿是HRV的易感人群。

Objective To understand the relationship between human rhinovirus（HRV） and acute respiratory infections in infants and young children in Beijing. Methods Throat swab/nasopharyngeal aspirates were collected from 3292 infants and young children with acute respiratory tract infections in Beijing from November 2002 to November 2006. Primers derived from the highly conserved 5＇-noncoding region of human rhinovirus were used to detect HRV from clinical specimens by nested RT-PCR for which the sensitivity and specificity had been determined previously. Results Out of these 3292 specimens, 507 were （ 15.4 % , 507/3292） HRV positive with RT- PCR method. HRV were detected from 220 out of 1315 outpatients and 287 out of 1977 inpatients with positive rates as 16.7 % and 14.5 % respectively. HRV was detected from 50.0 % （8/16） of the patients with pharyngitis. Among 280 specimens collected from patients with acute bronchitis, 43 （15.4%） were HRV positive, including 14 from 80 patients with wheezy bronchitis （17.5%）. High positive rates were also found in specimens from patients with pneumonia （ 12.6 % , 150/1189）, bronchiolitis （ 16.0 %, 42/262） and asthma （ 12.8 %, 10/78 ）. In 53 patients with initial diagnosis as hematic disease or other complicate respiratory infections, 14 were HRV （26.4% ,14/53） positive. As for the seasonal distribution, HRV were detected in most of the months during thie period of research. The highest positive rate of HRV in each year fell in September （32.6%）, February （24.2%） of 2004, February of 2005 （35.3 % ） and March （31.3 % ） from 2003 to 2006, respectively. Among these HRV positive patients,44.8% were under 1 year of age （227/507）,15.4% （78/507） were 1 to 2 years old and 12.4 % （63/507） were 2 to 3 years old. Conclusion HRV was associated with acute upper respiratory infections and lower respiratory infections including bronchitis, pneumonia and bronehiolitis in pediatric patients. Patients with lower immunity such as those with hematic diseases, were more susceptible to be infected by HRV. HRV could be detected in all age groups in this study, but the positive rates were decreasing with the increase of patients＇ age. Infants under 1 year of age seemed to be more likely to get HRV infection.