2006—2008年苏州地区儿童呼吸道人偏肺病毒感染的流行和临床特征

Epidemiological and clinical features of human metapneumovirus infection in children between 2006 and 2008 in Suzhou area

目的了解人类偏肺病毒(hMPV)在苏州地区小儿呼吸系统感染中的感染情况,分析其流行病学特点;探讨hMPV感染后的临床特征。方法选取2006年1月—2008年12月苏州大学附属儿童医院6 395例急性呼吸道感染住院患儿,总结临床特征;用逆转录-聚合酶链反应法(RT-PCR)检测痰液中hMPV N基因,随机挑选部分阳性PCR扩增产物进行核苷酸测定,并将所测序列在GenBank中进行比较分析。结果 6 395例标本中,检测到589份RT-PCR阳性扩增产物,检出率为9.2%,其中2006年度hMPV检出率为8.4%,2007年为7.6%,2008年为12.6%。hMPV在3年的每个月份都有检出,但在2006年12月、2007年1月和2008年5月呈现年度高峰,分别为24.2%、21.6%、31.9%。589例hMPV感染患儿的平均年龄为22.21个月;临床诊断上呼吸道感染3.6%,喉炎2.0%,毛细支气管炎20.2%,肺炎61.8%,哮喘急性发作12.4%。主要临床表现为咳嗽,鼻塞流涕,发热,呼吸困难,哺喂困难,喘息。20份hMPV N基因部分核苷酸片断与GenBank中hMPV N基因序列同源性为99%～100%。结论苏州地区部分儿童的呼吸道感染与hMPV有关。全年均存在hMPV感染,流行高峰在冬春季,连续3年的检出率有较大差异。hMPV感染的临床特征无特异性。

Objective To investigate the status of human metapneumovirus（hMPV）infection among children with respiratory tract infections in Suzhou area,to analyze epidemiological and clinical features of hMPV in children.Methods Six thousands three hundred and ninety-five patients admitted in Children＇s Hospital Affiliated to Suchow University with acute respiratory tract infection between January 2006 and December 2008 were recruited in the study.The clinical features were analyzed and the specimens collected from respiratory tract were inspected for the presence of hMPV by reverse-transcription polymerse chian reaction（RT-PCR）.PCR products of hMPV N gene from some patients were randomly selected for sequencing analysis,and the sequences of the nucleotides and deduced amino acids were compared with those in the GenBank.Results Among 6 395 patients,589（9.2%）had evidence of hMPV infection.The positive rate of hMPV in 2006,2007,and 2008 was 8.4%,7.6%,and 12.6 %,respectively.The peak times of positive rate of hMPV were December of 2006（24.2%）,January of 2007（21.6%）,and May of 2008（31.9%）,though it could be detected every month.The median age of patients was 22.21 months.hMPV was identified in patients with either upper or lower respiratory tract infection or both.The infected children were diagnosed as having upper respiratory tract infection（3.6%）,laryngitis（2.0%）,bronchiolitis（20.2%）,pneumonia（61.8%）,and asthma exacerbation（12.4%）.Clinical manifestations included fever,cough,rhinorrhea,dyspnea,feeding difficulties and wheezing.Sequence analysis showed that 99% ～ 100% of the hMPV N genes were homologous with the sequence registered in GenBank.Conculsions This study showed that（1）hMPV accounted for a small but significant proportion of respiratory tract infection in infants and children.（2）hMPV infection occurred all the year round,but it prevailed predominantly in the winter and spring,the positive rate of hMPV was obviously different in the consecutive three years.（3）hMPV infection could not be discriminated from the infection of other respiratory tract viruses by clinical manifestations.