重庆儿童医院112例毛细支气管炎病原分布特征分析

Virus epidemiology and clinical characteristics of bronchiolitis infants in Chongqing region

目的探讨重庆地区住院毛细支气管炎患儿鼻咽分泌物中HBoV和其他10种呼吸道病毒检出率及其流行特征变化。方法收集2006-2008年的毛细支气管炎发病高峰季节(2006年11月至2007年3月和2007年11月至2008年3月)住院毛细支气管炎患儿的鼻咽分泌物,首先通过直接免疫荧光进行呼吸道常见7种病毒筛查,然后提取鼻咽分泌物病毒的DNA和RNA,用PCR/RT-PCR的方法检测HBoV等其余10种常见呼吸道病毒相应基因片段。结果①两时间段患儿的年龄比较,差异具有显著性(P<0.01)。临床症状中,发热、呕吐、气促的发生例数差异具有显著性(P<0.05)。其余情况差异均不显著;②重庆地区住院毛细支气管炎患儿鼻咽分泌物中共检出十余种呼吸道病毒,112例患儿呼吸道标本中共检出呼吸道病毒阳性84例(75%),其中单一病毒阳性45例(40.18%),2种或2种以上病毒合并阳性39例(34.82%),2006年11月至2007年3月和2007年11月至2008年3月毛细支气管炎发病高峰季节毛细支气管炎患儿病毒检出情况不同;③112例患儿中最常见的为RSV,其余依次为PIV3,RV等,检出HBoV10例,均为合并感染。结论①毛细支气管炎患儿鼻咽分泌物呼吸道病毒感染阳性检出率高,病毒种类复杂,合并感染率高。而且每年的病毒检出情况、合并感染情况、流行季节变化可能与不同年份患儿临床特征不同有关;②在住院毛细支气管炎患儿鼻咽分泌中新近发现HBoV感染,以合并感染为主,但其检出阳性率明显低于RSV和hMPV。

Objective To investigate the incidence human bocavirus（HBoV）,human metapneumovirus（hMPV）and other 9 respiratory viruses in bronchiolitis of children in Chongqing area and their clinical characteristics of such childhood bronchiolitis.MethodsHuman syncytial virus（RSV）,adenovirus（ADV）,influenza virus（Flu）A and B,parainfluenza virus（Para）1,2,3,associated with respiratory disorders from nasopharyngeal secretion in 112 infants with bronchiolitis admitted in our hospital from November 2006 to March 2007 and from November 2007 to March 2008 were assayed with rapid immunofluorescence method.At the same time,NP-1 and NS1 gene of HBoV,F gene of hMPV and other genes of the left 8 viruses were also detected with PCR or RT-PCR.ResultsClinical characteristics were significantly different between the bronchio-litic patients in the 2 years,such as their age,and clinical symptoms including fever,vomit and tachypnea.There were a dozen of respiratory viruses found in the nasopharyngeal secretion from 112 infants with bronchio-litis.The positive rate of the virus infection identified in the infants was 75%,45 of them（40.18%）were infected by single virus,and 39 cases（34.82%）were by mixed virus detection.Significant difference was found between the positive rate of the 2 years.Among these infants,RSV was most common followed by parainfluenza virus（PIV3）and rhinovirus（RV）.There were 10 cases positive to HBoV and all were detected with other respiratory viruses.ConclusionThese data suggest that there are more bronchiolitis infant positive to respiratory viruses in Chongqing region,characterized with complicated virus types and more concurrent infection.And the epidemic characteristic patterns are different even in 2 continuous years.RSV and hMPV are more common than HBoV as a primary pathogen in childhood bronchiolitis,and the later is always co-infected with other viruses.