苏州地区呼吸道合胞病毒及相关支气管肺炎患儿的流行病学研究

Epidemiological study on respiratory syncytial virus and its bronchopneumonia among children in Suzhou

目的对2001至2005年苏州地区急性呼吸道感染儿童中呼吸道合胞病毒(RSV)进行流行病学监测,探讨 RSV 支气管肺炎患儿细胞免疫学变化。方法应用直接免疫荧光法对10 205份急性呼吸道感染患儿鼻咽分泌物进行 RSV 等7种病毒抗原检测;用流式细胞仪对其中30例(年龄1.5～24.0个月)RSV 支气管肺炎(支肺)患儿外周血进行 CD3、CD4、CD8、CD19、CD16及 CD56指标测定。设同龄健康对照15例(年龄1.5～24.0个月)。结果 2001至2005年苏州地区 RSV 年阳性率分别为:24.94%、25.83%、24.05%、25.39%、27.30%,5年中流行高峰在11月至翌年3月;1～12个月婴幼儿 RSV 阳性率超过12个月以上年龄组(x^2=97.320,P<0.01),12个月以内各组 RSV 阳性率差异也有统计学意义(x^2=7.804,P<0.05,3～6个月组阳性率最高);男性患儿 RSV 阳性率高于女性(x^2=9.693,P<0.01);RSV 支肺患儿 CD3^+、CD4^+、CD8^+、NK(CD16+56)^+细胞百分率均低于正常对照组(t=3.199,P<0.0l;t=2.215,P<0.05;t=2.619,P<0.05;t=5.240,P<0.01),CD19^+细胞百分率则高于正常对照组(t=2.875,P<0.01)。结论苏州地区 RSV 流行具有明显的季节性;年龄越小 RSV 感染率越高,RSV 支肺患儿细胞免疫功能低下,对低年龄婴幼儿 RSV 感染的有效预防尤为重要;男性患儿 RSV 感染率高于女性,其原因有待探讨。

Objective To probe the epidemiological trend of respiratory syncytial virus （RSV） and cellular immunological change of RSV bronchopneumonia among children in Suzhou in the past five years. Methods 10 205 children with acute respiratory tract infection from January 2001 to December 2005 were enrolled into the study. Nasopharyngeal aspirates were obtained from the respiratory tract by aseptic vacuum aspiration. Direct immuno-fluorescence assay was employed to detect seven kinds of virus antigens including RSV antigen. CD3, CD4,CD8, CD19, CD16 and CD56 in peripheral blood mononuclear cells of 30 patients with RSV bronchopneumonia （1.5 -24. 0 months old group） were analyzed by flow cytometry analysis, and 15 normal infants（1.5 -24.0 months old group） were enrolled as control group. Results The annual positive rate of RSV was 24. 94%, 25.83%, 24. 05%, 25.39% and 27.30% respectively from 2001 to 2005. It also found that the peak season for RSV infection was spring or winter （January to March or November to December）. The positive rate of RSV was significantly higher in 1 - 12 months old group than that in 〉 12 months old group （ X^2 = 97. 320, P 〈 0. 01 ）, as well as the groups between 1 - 12 months old （ X^2 = 7. 804 ,P 〈 0. 05, the highest positive rate was occurred at 3 - 6 months old group）. The positive rate of RSV was significantly higher in boys than that in girls （X^2 = 9. 693, P 〈 0.01 ）. The percentages of CD3^＋ ,CD4^＋ ,CD8^＋ and NK（ CD16 ＋56） ＋ cells were significantly lower in RSV bronchopneumonia than those in control group（t = 3. 199, P〈0.01;t =2.215, P〈0.05; t =2.619, P〈0.05 and t =5. 240, P〈 0.01, respectively）. While the percentage of CD19^＋ cells was significantly elevated in RSV bronchopneumonia than that in control group （ t = 2. 875, P 〈 0.01 ）. Conclusion RSV infection is of obvious seasonal changes. The younger the patient, the higher positive rates of RSV infection is, while and the cellular immunity function is lower. The effective measures for preventing RSV infection are important,especially for the infants. Further investigation is necessary to understand the causes of the variations for RSV infections between boys and girls.