急性呼吸道感染患儿的病原学研究

Etiology investigation of acute respiratory tract infections in children

目的探讨苏州地区7岁以下儿童急性呼吸道感染（ARTI）的病原学分布。方法无菌负压吸引法采集1668侧7岁以下ARTI住院患儿新鲜痰液，细菌培养检测细菌，直接免疫荧光法检测7种呼吸道病毒，逆转录聚合酶链反应（RrPCR）法检测人类偏肺病毒（hMPV）N基因，酶联免疫吸附试验（ELISA）法检测血清肺炎支原体（MP）抗体。结果1668例患儿中，病原检测阳性1107例（66．4％），其中单纯病毒感染359例（21．5％），单纯细菌感染271例（16．3％），单纯肺炎支原体感染222例（13．3％），混合感染255例（15．3％）。病毒以呼吸道合胞病毒（RSV）为主（19．2％），人类偏肺病毒（hMPV）次之（12．0％）；细菌则以肺炎链球菌为主（12．0％），其次为流感嗜血杆菌（3．8％）。结论①本地区7岁以下ARTI儿童最常见病原是病毒，其次是细菌、支原体。②RSV是本地区冬春季低年龄婴幼儿ARTI的主要病原。流感病毒、副流感病毒感染无流行迹象。本地区hMPV在2008年3～5月有一流行高峰。肺炎链球菌、流感嗜血杆菌是主要的细菌病原。MP感染多见于1岁以上儿童。混合感染则多见于3岁以下儿童。

Objective To investigate the etiology of acute respiratory tract infections（ARTI） in children under 7 years old in Suzhou. Methods Bacteria and virus were tested using sputum culture and direct immunofluoresence respectively. Human metapneumovirus（hMPV） gene fragments were detected by reverse transcription polymerase chain reaction. Antibodies against myeoplasma was detected by enzyme-linked immunosorbent assay in paired sera. Results Etiological agents were identified in 1 107 cases（66.4%） out of 1 668 patients. Viral infections were in 359 cases （21.5 % ）, bacterial infections were in 271 cases（ 16.3 % ）, and Mycoplasma pneumoniae 222 cases （ 13.3 % ）, compound infections 255 cases （15.3%）. Respiratory syncytial virus （RSV） was the major viral pathogen, followed by hMPV. Streptococcus pneumoniae was the prominent pathogen of bacterial pneumonia, followed by Haemophilus influenzae. Conclusion （1）Viral infection is the most common cause of ARTI in children under 7 years old in Suzhou,followed by bacteria and mycoplasma. （2）RSV is the major cause of ARTI in infants and young children during winter and spring in Suzhou. There is no evidence of outbreak of influenza and parainfluenzae virus infection. There is a peak of hMPV infection from March to May in 2008. Streptococcus pneumoniae and Haemophilus influenzae are the prominent pathogens of bacterial pneumonia. Mycoplasma pneumoniae infection is more common in children older than 1 year old, compound infection is more often in children less than 3 years old.