儿童急性下呼吸道感染病毒病原学2007—2010年监测

Three years surveillance of viral etiology of acute lower respiratory tract infection in children from 2007 to 2010

目的了解儿童急性下呼吸道感染（ALRTI）的病毒病原学构成及其流行的季节特征。方法2007年3月-2010年3月首都医科大学附属北京儿童医院急救室就诊及内科住院的ALRTI患儿共1914例。采集每例患儿鼻咽吸取物1份，用（RT）PCR方法进行病毒核酸检测，包括呼吸道合胞病毒（RSV），人鼻病毒（HRV），副流感病毒（PIV）1～4型，流感病毒（IFA、IFB和IFC），腺病毒（ADV），肠道病毒（EV），冠状病毒（HCOV），偏肺病毒（HMPV）及博卡病毒（HBOV）。结果（1）总的病毒阳性检出率70．3％，其中〈1岁、1-〈3岁、3～〈6岁和≥6岁组分别为83．0％、80．1％、60．8％和27．7％，其差异有统计学意义（X2=2213．5，P=0．000）。检出率高的前3种病毒依次为RSV、HRV和PIV，其在〈1岁组分别是50．9％、36．2％和12．0％。（2）RSV和HRV的流行季节在冬春，而PIV在春夏。（3）〈1岁、1～〈3岁、3～〈6岁和36岁组病毒阳性患儿中检出2种以上病毒的比例分别为38．2％、36．4％、30．2％和15．2％，其差异有统计学意义（x2=1346．00，P=0．000）。结论病毒是小年龄儿童ALRTI的主要病原，以RSV、HRV和PIV最为重要，其感染存在季节特征；ALRTI患儿存在多种病毒感染，其临床意义有待进一步研究。

Objective Viruses are common pathogens of acute lower respiratory tract infection （ALRTI） in children. There are few studies on consecutive monitoring of viral pathogens of ALRTI in a larger cohort during the past several years. The aim of this study was to investigate the viral pathogens of ALRTI in children of different age groups and to outline the epidemic feature of different viruses. Method （ 1 ） Totally 1914 （ 1281 male and 709 female） children with clinical diagnosis of ALRTI during the period of March 2007 to March 2010 were recruited into this study. These patients were hospitalized patients in department of internal medicine or outpatients in emergency department in Beijing Children＇s Hospital. The patients were divided into four groups, including 1072 patients 〈 1 year old, 326 patients 1 - 〈 3 years old, 158 patients 3 - 〈 6 years old, 358 patients ≥ 6 years old. One nasopharyngeal aspirate specimen was collected from each patient. Reverse transcription （RT）PCR methods were applied to detect common respiratory viruses including respiratory syneytia] virus （ RSV）, human rhinovirus （ HRV ）, influenza virustype A, B and C （ IFA, IFB, IFC ）, parainfluenza virus （PIV） type 1 - 4, adenovirus （ADV） , enterovirus （ EV）, human coronavirus （ HCOV）, human metapneumovirus （HMPV） and human bocavirus （HBOV）. Result （ 1 ） The total positive rate of viruses was 70. 3%. The positive rate was 83.0% （890/1072） in the group of 〈 1 year old, and 80. 1% （261/326） in group of 1 - 〈3 years old, 60. 8% （96/158） in group of 3 - 〈 6 years old and 27.7% （99/358） in group of ≥ 6 years old, respectively. There was a significant difference in the positive rate among different age groups（ X2 = 2213.5 ,P = 0. 000）. The top three viruses were RSV, HRV and PIV; and the positive rates were 50. 9% , 36. 2% and 12. 0% respeetively in group of 〈 1 year old. （2） The epidemic seasons of RSV and HRV were winter and spring, and PIV infection was epidemie in spring and summer. （3） The deteetion rates of 2 or more viruses were 38.2% , 36.4% , 30. 2% and 15.2% in groups of 〈1 year old, 1 - 〈3 years old, 3- 〈6 years old and /〉6 years old, respeetively. There was a significant difference in the mixed infection rate among different age groups （X2 = 1346. 00,P =0. 000）. Conclusion RSV, HRV and PIV were the most predominant pathogens in younger children with ALRTI. Different viral infections had different seasonal features. Mixed infections with two or more viruses were deteeted in substantial proportion of patients with ALRTI, but further studies are needed to explore the clinical signifieanee of mixed infeetion with viruses in patients with ALRTI.