上海地区婴幼儿院内感染轮状病毒致腹泻病的分子流行病学调查

Molecular epidemiology of rotavirus among infants and young children with nosocomial diarrhea in Shanghai area

目的了解上海地区婴幼儿院内感染轮状病毒（RV）致腹泻病的分子流行病学特征。方法采用胶体金法和套式PCR，对2006年11月至2008年1月复旦大学附属儿科医院收集的226例院内感染性腹泻患儿的粪便标本进行RV病原检测，并对阳性标本进行分型，调查患儿的临床特征。数据分析分别以构成比、阳性检出率表示，均值采用t检验。结果胶体金法RV阳性率为47．8％。院内感染RV腹泻以1岁以内的年龄段最高，新生儿占RV腹泻患儿的32．4％。发病高峰在10、11月份。采用套式-PCR对除新生儿外的67份RV阳性标本进行分型，G3为主要流行的血清型，占46．3％，其次为G1占23．9％、G2占3.0％、G9占1．5％，7份为混合感染，均为G1、G3混合，10份未能分型。从P分型来看，主要流行株为P[8]型，占90.0％，其次为P[4]型占6．0％，3份标本未能分型。未发现P[6]、P[9]和P[10]型。G3P[8]为主要分离株，占61．2％，其次为G1P[8]，占17．9％，G1、G3P[8]混合感染占9．5％，G2P[4]、G8P[9]各1例。新生儿32份RV阳性标本中10份成功分型，均为G1P[8]。院内感染RV腹泻延长住院天数、增加住院费用。结论RV是上海地区院内感染性腹泻病的主要病原，其流行的主要血清型为G3P[8]型，但仍需加强监测G1流行株的暴发流行。

Objective To investigate the characteristic of rotavirus（RV） molecular epidemiology among infants and young children with nosocomial diarrhea in Shanghai area. Methods Two hundred and twenty-six stool specimens collected from inpatients with nosocomial diarrhea from November 2006 to January 2008 were measured by colloidal gold assay and nested polymerase chain reaction （PCR）. The positive samples were typed to investigate the clinical characteristics of patients. The data were shown with constituent ratio and positive detection rate. The analysis was done by using t test. Results RV was detected in 108 of 226 specimens （47.8%） by colloidal gold assay. The incidence was highest in infants younger than one year old. Neonatal cases with RV accounted for 32.4% of all RV nosocomial infections recruited. The peak seasons were October and November. RV serotyping in 67 cases older than 1 year old by nested PCR showed that G3 was predominant and accounted for 46.3%, followed by G1（23.9%）, G2 （3.0%）, G9（1.5%）, seven cases were eoinfections with G1 and G3 （10.4%） and 10 couldnrt be typed. Based on P typing, P[8] was predominant genotype with 90.0%, PE[4] accounted for only 6.0% and 3 couldn＇t be typed. P[6], P[9] and P[10] haven＇t been detected. G3P[8] was the major isolates which accounted for 61.2%, followed by GIP[8] （17.9%）,G1 and G3P[8] coinfection accounted for 9.5 G. Two cases were infected with G2P[4] and G8P[9], respectively. Ten out of 32 neonatal specimens were typed successfully which were G1P[8]. Nosocomial RV diarrhea resulted in prolonged hospital stay and increased medical cost. Conclusions RV is the major etiological agent of nosocomial diarrhea among infants and young children in Shanghai area. G3P[8] is the predominant serotype. And the outbreak of G1 epidemic strain infection should be monitored.