重庆市秋冬季支气管哮喘患儿急性加重与呼吸道非细菌病原感染分析

Relative Analysis of Asthma Acute Exacerbation and Non-Bacterial Respiratory Tract Infection in Children in Chongqing during Autumn and Winter

目的分析重庆市秋冬季儿童支气管哮喘(哮喘)急性加重与呼吸道非细菌病原感染的关系。方法对179例哮喘急性加重患儿鼻咽部分泌物用免疫荧光快速检测7种病毒抗原:呼吸道合胞病毒(RSV)、腺病毒(AdV)、流感病毒A(IVA)、流感病毒B(IVB)、副流感病毒1(PIV1)、副流感病毒2(PIV2)、副流感病毒3(PIV3);PCR法检测肺炎支原体(MP)-;;DOI:10.3969/j.issn.NA、肺炎衣原体(CP)-;;DOI:10.3969/j.issn.NA;ELISA法检测其血清RSV-IgM、AdV-IgM、柯萨奇病毒(CBV)-IgM、巨细胞病毒(CMV)-IgM、EB病毒(EBV)-IgM及MP-IgM、CP-IgM水平。结果 179例患儿检出病原120例,阳性率为67%,检出病原前3位为CBV 52例(29.1%)、RSV 44例(24.6%)、MP 26例(14.5%)。5岁以上组病原检出前3位为MP 12例(30%)、CBV 11例(27.5%)、AdV 5例(12.5%),5岁以下组病原检出前3位为CBV 41例(29.5%)、RSV 40例(28.8%)、MP 14例(10.1%),2组RSV、MP检出率差异有统计学意义(Pa<0.05)。哮喘并间质性肺炎159例(88.8%),其中5岁以下组128例(71.5%),5岁以上组31例(17.3%),二组比较差异有统计学意义(P<0.05)。5岁以下组RSV比MP、CBV检出阳性病例住院时间更长。结论 MP、RSV为诱发儿童哮喘急性加重的常见病原,5岁以上患儿MP检出阳性率高,5岁以下患儿RSV检出阳性率高。呼吸道非细菌感染为哮喘急性加重的主要诱因,以5岁以下显著,尤其RSV阳性者住院时间更长。

Objective To analyze the relativity between non-bacterial respiratory tract infection and acute exacerbation of asthma in children in autumn and winter.Methods From 179 asthma acute exacerbation children′s rhinopharynx secretions,7 viruses antigen including respiratory syncytial virus（RSV）,adenovirus（AdV）,influenza virus A（IVA）,influenza virus B（IVB）,parainfluenza virus 1（PIV1）,parainfluenza virus 2（PIV2） and parainfluenza virus 3（PIV3） were rapidly detected by immunofluorescence.MP-DNA and CP-DNA were detected by polymerase chain reaction（PCR）.RSV-IgM,AdV-IgM,coxsackie B virus（CBV）-IgM,cytomegalovirus（CMV）-IgM,epstein-barr virus（EBV）-IgM and MP-IgM,CP-IgM in serum were examined with enzyme linked immunosorbent assay（ELISA）.Results In 120 cases out of 179 patients（67%）,the pathogens were found in rhinopharynx secretions.The top 3 pathogens discovered were CBV[52 cases（29.1%）],RSV[44 cases（24.6%）] and MP[26 cases（14.5%）].Among the group of ages above 5,the top 3 pathogens detected were MP[12 cases（30%）],CBV[11 cases（23.5%）] and AdV[5 cases（12.5%）].In the group of ages below 5,the top 3 pathogens were CBV[41 cases（29.5%）],RSV[40 cases（28.8%）] and MP[14 cases（10.1%）].The frequency of RSV and MP detection had significant differences between the 2 groups（Pa0.05）.Among the 159 cases of asthma associated complication were interstitial pneumonia,128 cases（71.5%） cases were younger than 5-year-old,31 cases（17.3%） cases were older than 5-year-old,which showed a significant diffe-rence（P0.05）.The patients younger than 5-year-old with RSV positive were hospitalized for a longer time than those with MP and CBV positive.Conclusions MP and RSV are common etiological agents which implicate asthma acute exacerbation in children.It has a higher frequency of MP detection in patients older than 5-year-old,and a higher frequency of RSV detection in patients younger than 5-year-old.Non-bacterial respiratory tract infection can be implicated exacerbation of asthma,especially for under 5-year-old patients,RSV positive patients in this group are hospitalized for a longer time.