1527例喘息住院患儿病毒病原学分析

The viral pathogen of the hospitalized children with wheezing diseases

目的了解当前喘息儿童病毒感染病原学的状况。方法对2010至2011年因喘息住院治疗的1527例儿童应用逆转录PCR方法检测人类偏肺病毒（hMPV），实时PCI0方法检测人类博卡病毒（hBoV），同时采用直接免疫荧光法检测呼吸道分泌物中呼吸道合胞病毒（RSV）、流感病毒（IVA、IVB）、副流感病毒（PinfⅠ～Ⅲ）和腺病毒（ADV）。结果1527例患儿的标本中病毒检测阳性者705例，总检出率46．2％，其中〈3岁患儿占90．1％；分别为RSV344例（22．5％）、PinfⅢ156例（10．2％），hBoV89例（5．8％），hMPV60例（3．9％），ADV18例（1．4％），PinfI18例（1．2％），IVB11例（O．7％），IVA8例（0．5％），PinfⅡl例（0．1％）。合并感染2种病毒者38例，最常见为hMPvA并hBoV感染（21．1％）和RSvA并hBoV感染（21．1％）。相比hMPV．PinfⅢ、hBOV感染患儿，RSV感染患儿的平均年龄小，气促、呼吸困难、紫绀表现更多见，平均住院时间更长，差异均有统计学意义（P〈O．05）。RSvJ惑染于每年的1至3月及10至12月间流行，hMPV的检出高峰在2至4月，PinfⅢ的检出高峰在6至7月，hBoV的检出高峰在6至8月。结论RSv是诱发儿童喘息最常见的病毒病原，hBoV和hMPV位居第3、4位，Rsv为冬春季节引起喘息的主要病原，PinfⅢ、hBoV为夏秋季节引起喘息的主要病原。hMPV和hBoV感染后的临床症状无特异性，RSV感染怠扎年龄较小、病情柱对重。

Objeetive To study the viral pathogen of the hospitalized children with wheezing diseases. Methods Sam ples obtained from 1527 children hospitalized with wheezing during 2010 to 2011, were tested for virus pathogens. Nasopha ryngeal aspirates were obtained from children according to a standard protocol and were tested for respiratory syncytial virus （RSV）, influenza viruses A and B, parainfluenza virus types Ⅰ, Ⅱ, and Ⅲ and adenovirus with direct immunofluorescence assay. Samples were tested for human metapneumovirus （hMPV） with reverse transcription polymerase chain reaction （RT PCR） and for human bocavirus （hBoV） by polymerse chian reaction （PCR）. Results Viral infection was identified in 46.2% of 1527 specimens, of which 90.1% were from patients younger than 3 years. The positive rate of RSV was 22.5%, Pinf III 10.2%, hBoV 5.8%, hMPV 3.9%, ADV 1.4%, PinfI 1.2%, IVB 0.7%, IVA 0.5%, Pinf Ⅱ 0.1%. The simultaneous infection of two types of viruses was found in 38 cases. The most common simultaneous infections were hMPV combined hBoV （21.1%） and RSV combined hBoV （21.1%）. The average age of the RSV-infected children was 10.27 month, younger than that of hMPV, Pinf Ⅲ and hBoV-infected children （P〈0.05）. However, the shortness of breath, dyspnea and cyanosis were found more frequently in RSV-infected children （P〈0.05）. The mean duration of hospital stay of RSV-infected children were longer. RSV-positive sam ples were detected most frequently during January to March and October to December. hMPV-positive samples were detected most frequently during February to April. Pinf Ⅲ-positive samples were detected most frequently during June to July. Most of the hBoV-positive samples were detected during June to August. Conclusions RSV is the most common viral pathogen lea- ding to wheezing, and hBoV and hMPV rank third and fourth. RSV prevails predominantly in the winter and spring. Pinf Ⅲ and hBoV prevail predominantly in the summer and autumn. Clinical symptoms associated with hMPV infection are similarwith those associated with hBoV. RSV is detected more frequently in the younger children and situation is relatively moreserious.