先天性心脏病合并下呼吸道感染患儿病毒病原学分析

Viral etiology of lower respiratory tract infection in children with congenital heart disease

目的分析因先天性心脏病合并下呼吸道感染住院患儿病毒感染的情况。方法将2003年1月—2008年12月住院治疗的先天性心脏病合并下呼吸道感染181例患儿(CHD组)纳入研究,回顾性分析其鼻咽分泌物呼吸道合胞病毒(RSV)、副流感病毒3(PIV3)等7种常见呼吸道病毒的检测结果,并与同期同年龄段的无先天性心脏病的下呼吸道感染住院患儿(LRI组)比较。结果 CHD组RSV阳性率29.8%,显著低于LRI组的40.6%(χ2=8.48,P<0.01);PIV3阳性率10.5%,显著高于LRI组的5.2%(χ2=9.96,P<0.01),其余病毒阳性率较低。1～6月龄中CHD组RSV阳性率显著低于同龄LRI组(P<0.01),在7～12月龄和夏秋季中CHD组PIV3阳性率分别显著高于同龄和同季节LRI组(P均<0.01)。结论 CHD组的呼吸道病毒感染谱与LRI组相似,但RSV感染率较低,PIV3感染率较高;RSV感染率低主要是来自1～6月龄组患儿,PIV3感染率高主要来自7～12月龄和夏秋季节的患儿。

Objective To study the viral etiology of lower respiratory tract infection（LRI） in hospitalized children with congenital heart disease（CHD）.Methods Cases were from hospitalized children with LRI from January 2003 to December 2008.A total of 181 CHD children,aged from 1 month to 12 months,were enrolled in group CHD,8 330 age-matched,non-CHD children were studied as controls（group LRI）.Direct immunofluorescence was used to detect the respiratory syncytial virus（RSV）,adenovirus（ADV）,influenza virus（IV） A and B,parainfluenza virus（PIV） type 1,2,3 from nasopharyngeal secretions collected from these patients,a retrospective study was performed.Results The positive rate of RSV in group CHD was significantly lower than that of group LRI（29.8% vs.40.6%,χ2 = 8.48,P 0.01）,especially among 1-6 months old babies（28.7% vs.44.3%,χ2 = 12.4,P 0.01）.The positive rate of PIV3 in group CHD was significantly higher than that of group LRI（10.5% vs.5.2% χ2 = 9.96,P 0.01）,particularly among 7-12 months babies during summer or autumn（13.5% vs.4.3%,χ2 = 8.02,P 0.01 or 21.3% vs.10.7%,χ2 = 8.46,P 0.01）.Other viruses were rarely found.Conclusions RSV and PIV3 play the leading and the second pathological cause in both groups,respectively.However,RSV infection was more common in group LRI and PIV3 infection was more common in group CHD.