儿童急性上呼吸道感染夏季和冬季病毒病原学分析

Etiology Study on Virus in Children with Acute Upper Respiratory Infection during Summer and Winter

目的了解秦皇岛地区儿童急性上呼吸道感染夏季和冬季病毒病原学的特点。方法选择2010年6—8月和2010年11月—2011年1月来我院门诊就诊的急性上呼吸道感染患儿169例和152例,采用多重聚合酶链反应(PCR)方法,检测321份咽拭子样本的腺病毒A/B/C/D,冠状病毒229E/NL63,1、2、3型副流感病毒,冠状病毒OC43/HKU1,鼻病毒A/B/C,甲型流感病毒,呼吸道合胞病毒A、B,博卡病毒1/2/3/4,乙型流感病毒,偏肺病毒,副流感病毒4型,肠道病毒共15种呼吸道病毒。结果共检测标本321份,阳性208份,检出率为64.8%。其中检出单一病毒185例:肠道病毒55例,流感病毒41例,呼吸道合胞病毒32例,腺病毒24例,鼻病毒17例,间质肺病毒6例,冠状病毒6例,博卡病毒4例。同时检出两种病毒23例:呼吸道合胞病毒与流感病毒7例,肠道病毒与腺病毒3例,腺病毒与流感病毒3例,腺病毒与呼吸道合胞病毒3例,肠道病毒与鼻病毒2例,肠道病毒与呼吸道合胞病毒1例,肠道病毒与博卡病毒1例,流感病毒与冠状病毒1例,腺病毒与鼻病毒1例,腺病毒与间质肺病毒1例。夏季检出病毒主要为肠道病毒、腺病毒、流感病毒;冬季检出病毒主要为呼吸道合胞病毒、流感病毒、腺病毒;鼻病毒、冠状病毒、间质肺病毒、博卡病毒等均为散发。肠道病毒夏季检出率为25.7%(49/191),冬季为3.6%(64/169),差异有统计学意义(χ2=33.846,P=0.000);流感病毒夏季检出率为7.3%(14/191),冬季为16.0%(27/169),差异有统计学意义(χ2=6.642,P=0.010);呼吸道合胞病毒夏季未检测出,冬季检出率为18.9%(32/169),差异有统计学意义(χ2=39.694,P=0.000);腺病毒夏季检出率为7.3%(14/191),冬季为5.9%(64/169),差异无统计学意义(χ2=0.288,P=0.592)。0～岁组病毒检出率为77.8%,1～岁组病毒检出率为91.8%,3～岁组病毒检出率为63.7%,6～14岁组病毒检出率为29.5%,差异有统计学意义(χ2=14.165,P=0.002)。结论肠道病毒、流感病毒、呼吸道合胞病毒、腺病毒为秦皇岛地区儿童急性上呼吸道感染的主要病毒。夏季与冬季病原菌不同:夏季为肠道病毒、腺病毒、流感病毒;冬季为呼吸道合胞病毒、流感病毒、腺病毒。夏季幼儿及学龄前儿童易出现病毒感染,冬季婴幼儿病毒感染多见。

Objective To evaluate etiologic characteristics of virus in children with acute upper respiratory infection （AURI） during summer and winter in Qinhuangdao district. Methods 169 AURI children admitted from June to August in 2010 and 152 AURI children admitted from November 2010 to January 2011 were involved into the study. Multiplex PCR method was used to detect 15 kinds of viruses in 321 samples of throat swab, including adenovirus A/B/C/D, coronavirus 229E/NL63, parainfluenza virus 1, 2 and 3, coronavirus OC43/HKUI, rhinovirus A/B/C, influenza virus A, respiratory syncytial virus A/ B, boeavirus 1/2/3/4, influenza virus B, metapneumovirus, parainfluenza virus 4 and enterovirus. Results A total of 321 samples were detected, and 208 samples were positive, with a detection rate of 64. 8%. 185 samples had single virus, inclu- ding 55 cases of enterovirus, 41 cases of influenza virus, 32 cases of respiratory syncytial virus, 24 cases of adenovirus, 17 ca- ses of rhinovirus, 6 cases of metapneumovirus, 6 cases of coronavirus and 4 cases of bocavirus. 23 samples had two kinds of vi- ruses, including 7 cases of respiratory syncytial virus combined with influenza virus, 3 cases of enterovirus combined with adeno- virus, 3 cases of adenovirus combined with influenza virus, 3 cases of adenovirus combined with respiratory syncytial virus, 2 cases of enterovirus combined with rhinovirus, one case of enterovirus combined with respiratory syncytial virus, one case of enterovirus combined with bocavirus, one case of influenza virus combined with coronavirus, one case of adenovirus combined with rhinovirus, and one case of adenovirus combined with metapneumovirus. Viruses detected in summer were mainly enterovirus, adenovirus and influenza virus; while the viruses detected in winter were mainly respiratory syncytial virus, influenza virus and adenovirus. Rhinovirus, coronavirus, metapneumovirus and bocavirus were sporadic type viruses. The detection rates of entero- virus in summer and winter were 25.7 % （49/191 ） and 3.6% （64/169） respectively, and the difference was statistically signifi- cant （ χ2 = 33. 846, P = 0. 000）. The detection rates of influenza virus in summer and winter were 7.3% （ 14/191 ） and 16.0% （27/169） respectively, and the difference was statistically significant （ χ2 = 6. 642, P = 0. 010）. The respiratory syncytial virus was not detected in summer, and the detection rate in winter was 18.9% （32/169）, showing statistically significant difference （χ2 = 39. 694, P = 0. 000）. The detection rates of adenovirus in summer and winter were 7.3% （14/191） and 5.9% （64/ 169） respectively, showing no statistic.ally significant difference （χ2 = 0. 288, P = 0. 592） . The detection rates in 0 - year old group, 1 - year old group, 3 - year old group and 6 - 14 year old group were 77.8% , 91.8%, 63.7% and 29.5% respec- tively, showing statistically significant difference （χ2 = 14. 165, P =0. 002）. Conclusion Enterovirus, influenza virus, re- spiratory syncytial virus and adenovirus are the dominant viruses among AURI children in Qinhuangdao. The main pathogens are different in summer and winter, with summer being enterovirus, adenovirus and influenza virus and winter being respiratory syn- cytial virus, influenza virus and adenovirus. Toddlers and preschoolers are susceptible to virus infection in summer while infants are vulnerable to virus attack in winter.