温州地区5岁以下住院儿童社区获得性肺炎病原学分析

A Study of Viral Etiology of Inpatients below 5 Years Old with Community Acquired Pneumonia in Wenzhou

目的探讨温州地区5岁以下住院患儿社区获得性肺炎(community acquired pneumonia,CAP)病毒病原学感染状况,为临床合理用药提供依据。方法 2009年2月—2010年1月在温州医学院附属育英儿童医院儿科确诊为CAP的5岁以下住院患儿,入院当天或次日清晨取其鼻咽部分泌物,采用直接免疫荧光法分别检测呼吸道合胞病毒(RSV)、腺病毒(ADV)、流感病毒A、B型(IVA、IVB)和副流感病毒Ⅰ、Ⅱ、Ⅲ型(PIV Ⅰ、PIV Ⅱ、PIV Ⅲ)7项呼吸道病毒抗原。结果 2247例患儿中,阳性843例,阳性率为37.52%。其中RSV 633例,占75.09%;PIV III 93例,占11.03%;IVA55例,占6.53%;PIV Ⅰ 22例,占2.61%;ADV 17例,占2.00%;IVB 6例,占0.71%;混合感染17例,占2.04%。结论 2009—2010年度温州地区5岁以下住院患儿CAP病毒病原以RSV为主,其次为PIV Ⅲ,IVA和PIV Ⅰ;病毒流行高峰为冬春季节;RSV的检出率从11月开始逐渐升高(23.16%),1、2月达高峰(分别为69.26%、49.81%),持续到次年4月(18.50%),以后逐渐下降,6、7月最低(均为1.01%)。婴幼儿是病毒性肺炎防治的重点。

Objective To investigate the viral etiology of inpatients below 5 years old with community acquired pneumonia（CAP） in Wenzhou.Methods Children below 5 years old admitted to Yu Ying Children＇s Hospital due to CAP between February 2009 and January 2010 were enrolled into the study.Their nasopharyngeal secretions（NPS） were obtained as soon as possible（usually within 24h） for identification of seven kinds of respiratory viral antigens by direct immunofluorescence assay.Results 2247 cases were included in the study,with 37.52% positive rate for some types of viruses.Respiratory syncytial virus（RSV） accounted for 633（75.09%）,parainfluenza virus Ⅲ（PIV Ⅲ） 93（11.03%）,influenza virus A（IVA） 55（6.53%）,parainfluenza virusⅠ（PIVI） 22（2.61%）,adenovirus（ADV） 17（2.00%）,influenza virus B（IVB） 6（0.71%）,and mixed infection 17（2.04%）.Conclusion RSV infections were dominant in inpatient children below 5 years old with CAP in Wenzhou,followed by PIV Ⅲ,IVA and PIV I.The peak season for RSV infection was spring and winter（January to April or November to December）.So it is very important that prevention and control of community acquired pneumonia among children be enhanced.