沈阳市类流感样病例病原检测分析

Etioligy analysis of influenza like illness in Shenyang

目的运用多重巢式反转录聚合酶链反应（multiplex nested reverse transcription polumerase chainreaction，多重巢式RT—PCR）快速检测类流感样病例（influenza like illness，ILI）相关病原，掌握流感症状人群的病原谱，并探讨类流感样病例百分比（Consultation rates of influenza—like illness，ILI％）作为流感流行监测指标的适用程度。方法于2007年1～4月采集辽宁省沈阳市纳入国家流感监测网络的医院门诊ILI病例咽拭子118份，同时采用传代狗肾（MDCK）细胞分离流感病毒，采用多重巢式RT—PCR检测13种类流感样病例相关病原，计算各病原的阳性率与构成比，并与同时期监测所得的ILI％比较。结果2007年1～4月，ILI％在5．0％左右波动，而流感病毒分离阳性率从峰值42．1％下降至0；多重巢式RT—PCR共检测出11种病原体，其中流感病毒阳性率亦从52．6％逐步下降至5．7％，鼻病毒、腺病毒和副流感病毒3者之和的阳性率在37．8％左右波动。结论结果提示，ILI的病原构成较复杂，难以从临床症状区分由流感病毒或其他病原导致的类流感样症状。因此，ILI％单独不足以表明流感病毒在人群中的流行情况，尚需辅助以敏感的实验室检测方法。

Objective Consultation rates of influenza - like illness （ILI%） in an outpatient setting have been regarded as a good indicator of influenza virus activity in community. In this study, we detected the etiology spectrum of the crowd with ILI to evaluate the efficiency of ILI%. Methods 118 ILI patients＇ nasopharyngeal swab specimens were collected in Shenyang between Jan. 2007 and Apr. 2007. All of the specimens were inoculated into MDCK cells for influenza virus isolation and analyzed for 13 pathogens （influenza A,B and C virus,syncytial virus,parainfluenza virus,human coronavirus,enterovirus, rhinovirus, human metapneumovirus, reovirus, adenovirus, MycopIasma pneumoniae, and Chlamydia pneumoniae） that could cause ILI symptom by multiplex nested RT - PCR assays. Each virus＇ positive and composing ratio was also cal- culated. The surveillance data of ILI% were also obtained at the same time. Results The ILI% among the outpatients from Jan. 2007 to Apr. 2007 was 5.0% on average. PCR positive rate of influenza virus was varied consistently from the peak in January 2007 （52.6%,10/19） to 40.0% （8/20） in February,22.8% （10/44） in March and 5.7% （2/35） in April; While rhinovirus, adenovirus, parainfluenza virus and Chlamydia pneumoniae together accounted for more than 30% of positive on average in the period. Conclusion Our data suggested that it was very difficult to ascertain whether the patient was really infected by influenza virus or other respiratory pathogens that could induce similar clinical symptoms, so the influenza surveillance should be carried out effectively by a systemic pathogenic test as well as sensitive clinical definition.