西藏拉萨地区儿童急性呼吸道感染病毒病原及其临床特点

Viruses and clinical features associated with hospitalized children with acute respiratory infections in Lhasa, Tibet

目的了解西藏拉萨地区因急性呼吸道感染住院的患儿的病毒病原及临床特点。方法采集西藏自治区人民医院儿科于2011年4至7月因急性呼吸道感染住院患儿的鼻咽分泌物标本，用直接免疫荧光法检测常见7种常见呼吸道病毒[呼吸道合胞病毒（RSV）、腺病毒（ADV）、流感病毒（INFA、INFB）、副流感病毒（PIV Ⅰ、Ⅱ、Ⅲ）]及新发人类偏肺病毒（hMPV）的抗原，并进行临床资料的统计及分析。结果（1）病毒抗原检测结果：共收集了167例患儿的标本，呼吸道病毒抗原阳性65例，阳性率为38．9％。检测到病毒67例份，其中有2例为2种病毒的合并感染，分别为RSV＋INFB和hMPV＋PIVⅢ型。RSV感染45例，占检测到病毒的67．2％，PIVⅢ7例，占检测到病毒的10．4％，ADV感染6例，占检测到病毒的9．0％，PIVI4例，占检测到病毒的6．0％，INFB型3例，占检测到病毒的4．5％，hMPV2例，占检测到病毒的3．0％。未检测到INFA和PIVⅡ。（2）本组临床特点：在RSV阳性者中，除临床表现为咳嗽、气促外，喘息症状少，但是大部分发绀现象较重，肺部细湿哕音多见。本组大部分患儿病情较轻，恢复快，少数年龄小有基础疾病或有合并症者病情重。结论病毒是西藏儿童急性呼吸道感染的重要病原之一，其中RSV感染最常见，主要发病年龄为3岁以下婴幼儿。

Objective To investigate the viral etiology and clinical features of hospitalized children with acute respiratory tract infections in Tibet. Method Nasopharyngeal aspirate samples were collected from children with acute respiratory tract infection hospitalized at the department of Pediatrics, Tibet Autonomous Region People＇s Hospital from April to July, 2011. The specimens of nasopharyngeal aspirate were screened for antigens of 7 common respiratory viruses by direct immunofluorescence （DIF） [ respiratory syncytial virus （RSV）, adenovirus （ADV）, parainfluenza viruses type I-III, influenza virus A and B ] and human metapneumovirus. Clinical data of the children were analyzed by statistical software SPSS16. Result A total of 167 children with acute respiratory tract infections hospitalized from April to July 2011 were enrolled in this investigation. Sixty-five out of 167 specimens were positive for viral antigens. The virus positive rate for specimens was 38.9% （65/167）. Two of 65 positive specimens were positive for 2 virus antigens （RSV ＋ influenza B ） and （hMPV ＋ parainfluenza virus type m ）, respectively. RSV was detected in 45 cases （67. 2%, 45/67） which was the most predominant, followed by parainfluenza virus type RI detected in 7 cases （ 10. 4%, 7/67）, ADV in 6 cases （9.0% , 6/67）, parainfluenza virus type I in 4 cases （6.0 % , 4/67 ）, influenza virus type B in 3 cases （4. 5% , 3/67）, and hMPV in 2 cases （3.0% , 2/67）. In addition to clinical manifestations of pneumonia, such as cough and shortness of breath, only 3 virus positive cases （6. 67% ） presented with wheezing, but the signs of severe cyanosis, fine rales in lung were common. Most of the children in this study recovered soon, only a few younger children with underlying diseases or complications had severe illness. Conclusion Virus is an important pathogen for acute respiratory infections for hospitalized children in Tibet. RSV was the most predominant etiological agent, especially for those younger than 3 years old.