儿童重症社区获得性肺炎病毒学检测和危险因素分析

Viral etiology and risk factors for severe community-acquired pneumonia in children

目的了解儿童重症社区获得性肺炎病毒病原谱,探讨儿童重症社区获得性肺炎的危险因素。方法收集2007年9月至2008年8月1096例社区获得性肺炎患儿的气道抽吸物标本,其中重症社区获得性肺炎100例。采用RT-PCR、PCR或巢式PCR方法对呼吸道病毒进行核酸检测。应用logistic回归法对患儿的临床相关资料进行单因素和多因素分析,以调查重症社区获得性肺炎的危险因素。结果 100例儿童重症社区获得性肺炎标本中,病毒总检出例数为82例(82%),其中RSV检出率最高(37%),其次为HBoV(25%)和HRV(18%)。2种及2种以上病毒协同感染32例(32%)。Logistic回归分析显示,合并基础疾病及RSV感染为儿童重症社区获得性肺炎发病的危险因素(分别OR=6.623,P<0.01;OR=1.672,P<0.05),月龄为保护因素(OR=0.475,P<0.01)。结论 RSV是儿童重症社区获得性肺炎最常见病毒病原;合并基础疾病及RSV感染是儿童重症社区获得性肺炎发病的危险因素,月龄为保护因素。

Objective To study the virus spectrum of severe community-acquired pneumonia（CAP） and risk factors for the disease in children. Methods Respiratory secretion specimens were collected from 1096 children hospitalized with CAP from June 2007 to November 2008,including 100 cases of severe CAP.Respiratory viruses were detected by PCR,nest-PCR or RT-PCR.Clinical data on the children were analyzed by univariate and multivariate logistic regression analysis for examining risk factors for severe CAP. Results Viral pathogens were isolated from 82（82%） of the 100 cases with severe CAP.RSV was the most common（37%）,followed by HBoV（25%） and HRV（18%）.Mixed infection was noted in 32 cases（32%）.The presence of underlying diseases（OR=6.623,P〈0.01） and RSV infection（OR=1.672,P〈0.05） were risk factors for severe CAP in children,while age was a protective factor（OR=0.475,P〈0.01）. Conclusions RSV is the most frequent viral pathogen in children with severe CAP.The presence of underlying diseases and RSV infection may be risk factors for severe CAP,while age is a protective factor.