急性呼吸道感染儿童两亚型呼吸道合胞病毒检测分析

Hospital-based epidemiology of respiratory syncytial virus infection in children with acute respiratory tract infections

目的了解2006—2007年度重庆地区住院急性呼吸道感染(ARTIs)儿童两亚型呼吸道合胞病毒(RSV)的感染特点及流行规律。方法收集2006年4月至2007年3月全年在重庆医科大学附属儿童医院呼吸科住院的部分ARTIs患儿的鼻咽深部吸取物390份,针对RSVG基因保守区序列设计分型引物,采用RT-PCR方法检测标本中RSV的基因组RNA。结果390例标本中RSV阳性例数为133例(133/390,阳性率为34.10%)。阳性标本中A亚型阳性129例,B亚型阳性4例。RSV阳性患儿中,84.9%为2岁以下小儿。2006年11月～2007年1月为RSV高发季节,RSV检测阳性率为55.6%～62.3%,2006年12月RSV检测阳性率最高。B亚型出现于本地区RSV感染低发季节(4、5、6月)。RSV感染的临床表现主要为发热(56.4%)、咳嗽(98.5%)、喘息(63.9%)、气促(76.7%)、紫绀(84.9%)。临床诊断依次为毛细支气管炎(33.1%),支气管肺炎(27.8%),间质性肺炎(18.1%),重症肺炎伴呼吸衰竭(10.5%),喘息性支气管炎(5.3%),支气管哮喘(4.5%)。结论本研究初步阐明了重庆地区两亚型RSV感染的流行病学特点,证实RSV是重庆地区冬春季婴幼儿ARI的重要病原,2006—2007年度以A亚型RSV流行为主。今后的研究将纳入门诊及社区患儿并进行多年度连续监测以进一步阐明重庆地区两亚型RSV流行规律及病毒进化特点。

Objective To primarily illustrate epidemiology of respiratory syncytial virus （ RSV ） infection of both subgroups in hospitalized children with acute respiratory tract infections （ ARTIs ） in Chongqing area. Methods Three hundred and ninty nasopharyngeal aspirates （NPAs） were collected from children with ARTIs hospitalized at the Children＇s Hospital Affiliated to Chongqing Medical University from April 2006 to March 2007. Primers targeting the G gene conserved region of RSV were used to develop a RT-PCR for detecting RSV and classification. Results Out of the 390 respiratory specimens, 133 （34. 10% ） were positive for RSV. Subgroup A and B viruses during the surveillance period accounted for 97% and 3% of the total positive samples ,respectively. Circulation of subtype B RSV was found in April,May and June when subtype A viruses were not commonly identified. One hundred and thirteen （ 84. 9% ） RSV positive specimens were from children under 2 years old. As for the seasonal distribution, RSV were detected in almost every month with high positive rates in winter in Chongqing. Clinical diagnosis of the RSV positive patients included bronehiolitis （33.1% ）, bronehopneumonia （27.8%） ,interstitial pneumonia （18.1% ）, severe pneumonia （10. 5% ） ,asthmatoid bronchitis （ 5.3% ） and bronchial asthma （ 4. 5% ）. The most common manifestations were fever （ 56.4% ） , coug- hing （ 98.5% ）, wheezing （ 63.9% ） , respiratory distress （ 76. 7% ） and cyanosis （ 84. 9% ）. Conclusion RSV is an important causative agent for acute respiratory tract infections in children in Chongqing. Subgroup A viruses are predominant in circulation during the surveillance period.Multiple-year study involving outpatient and community individuals will be required to further illustrate epidemiology in Chongqing area.