儿童急性下呼吸道感染病毒病原学研究

Study of viral etiology of acute lower respiratory tract infection in children

目的了解儿童急性下呼吸道感染(ALRTI)病毒病原学特点。方法2007年3月至2008年2月,在北京儿童医院内科就诊及住院治疗的临床诊断为ALRTI的患儿共572例。对每例患儿在就诊当日或次日采集鼻咽吸取物1份,采用逆转录(RT)-PCR方法进行常见呼吸道病毒核酸检测,包括呼吸道合胞病毒(RSV)、鼻病毒(RV)、副流感病毒(PIV)1～4型、甲型及乙型流感病毒(IFA、IFB)、腺病毒(AdV)、肠道病毒(EV)、冠状病毒(HCoV)、偏肺病毒(hMPV)及博卡病毒(HBoV)。结果572例患儿标本中,444例检出至少1种病毒,总检出率77.6%。各种病毒中,RSV检出率最高,占48.3%,其次是RV(27.1%)和PIV(13.3%)。不同年龄组病毒的总检出率差异有统计学意义,<3岁组检出率较高,≥5岁组病毒检出率明显降低。不同年龄组ALRTI病原谱有所不同,<5岁各组主要是RSV、RV、PIV,而≥5岁组则主要为RV、IFV、RSV。572例中,158例(27.6%)检出2种或2种以上病毒,<1岁患儿混合感染率最高,为40.2%,随年龄增长混合感染率逐渐下降,≥5岁患儿混合感染率仅为14.0%。结论就诊于北京儿童医院的ALRTI患儿中,5岁以下者ALRTI的主要病毒病原是RSV、RV、PIV;≥5岁则主要为RV、IFV、RSV。

Objective To investigate the viral pathogens of lower respiratory tract infection （ALRTI） in children. Methods Totally 572 children with clinical diagnosis of ALRTI during the period of March 2007 to February 2008 were involved in our study. One nasopharyngeal aspirate specimen was collected from each patient. （RT） PCRs were performed to detect common respiratory tract viruses including respiratory syncytial virus （RSV）, rhinovirus （RV）, influzenza virus type A and B （IFA, IFB） , parainfluenza virus （PIV） type 1-4, adenovirus （AdV） , enterovirus （EV）, human eoronavirus （HCoV）, human metapneumonia virus （hMPV） and human bocavirus （HBoV）. Results At least one Viral pathogen was detected in 444 out of 572 patients and the overall positive rate was 77.6%. The most common virus was RSV （48.3%）, followed by RV （27.1% ） and PIV （ 13.3% ）： The etiological spectrum of ALRTI varied in different age group. RSV, RV and PIV were the most predominant pathogens in children less than 5 years old while RV, IFV and RSV were the most common pathogens in children older than 5 years of age. Two or more viruses were identified in 158 out of 572 cases. The mixed infection rate was high （40.2%） in infants under 1 year old while it decreased to 14.0% in children older than 5 years of age. Conclusion RSV, RV and PIV are the most predominant pathogens in children less than 5 years old while RV, IFV and RSV are the most common pathogens in children older than 5 years of age in Beijing area.