2005—2011年苏州地区急性呼吸道感染住院儿童病原学研究

Etiology of acute respiratory tract infection in hospitalized children in Suzhou from 2005 to 2011

目的了解2005--2011年苏州地区急性呼吸道感染（ARI）住院患儿的病原检出情况。方法选取苏州地区2005年9月至2011年10月因ARI在苏州大学附属儿童医院住院治疗的患儿作为研究对象，共10243例。收集患儿临床资料，同时采集鼻咽部分泌物及血清标本进行多病原检测。应用直接免疫荧光法检测呼吸道合胞病毒（RSV）、流感病毒A（IV—A）和流感病毒B（IV—B）、副流感病毒1～3型（PIV-1～3）、腺病毒（ADV）；荧光定量PCR检测鼻咽分泌物中人类博卡病毒（HBoV）、肺炎支原体（MP）、肺炎衣原体（CP）；RT—PCR检测人类偏肺病毒（hMPV）；痰培养检测细菌；定量ELISA检测MP和CP的特异性抗体；分析病原检出情况、不同年龄患儿各病原检出率、各病原季节分布及其致病情况。结果10243例患儿中有5871例至少有1种病原检测结果为阳性，总检出率为57．32％（5871／10243），其中，病毒检出率为32．47％（3326／10243），细菌检出率为28．02％（2870／10243），不典型病原体检出率为26．94％（2759／10243）。MP是最常见的病原，检出率为25．74％（2637／10243）。病毒病原中RSV、PIV-3阳性患儿年龄中位数（分别为6、8月龄）小于患儿总体年龄中位数（12月龄）（χ2值分别为380．992、34．826，P值均〈0．05），而ADV、HBoV、IV—A阳性患儿年龄中位数（分别为42、14、24月龄）高于总体年龄中位数（χ2值分别为83．583、13．169、18．012，P值均〈0．05）；不典型病原MP患儿年龄中位数（30月龄）大于总体年龄中位数（χ2=728．299，P〈0．05）。细菌病原中肺炎链球菌和副流感嗜血杆菌阳性患儿年龄中位数（分别为17、21月龄）大于总体年龄中位数（x。值分别为60．463、8．803，P值均〈0．05）。0—6月龄、7月龄～1岁、2—3岁、4～5岁、≥6岁组患儿RSV检出率分别为25．59％（840／3283）、17．05％（333／1953）、11．85％（310／2615）、6．68％（90／1347）、2．87％（30／1045），检出率随年龄的增长而下降（x。=178．46，P〈0．01）；各年龄组患儿MP检出率分别为8．25％（271／3283）、19．46％（380／1953）、33．00％（863／2615）、41．43％（558／1347）、54．07％（565／1045），检出率随年龄增加而增加（χ2=379．21，P〈0．01）。RSV、IV—A好发于冬季，检出率分别为35．73％（941／2634）和4．44％（117／2634）；hMPV好发于冬春季节，春季为10．94％（277／2533），冬季为10．55％（278／2634）；HBoV好发于夏秋季节，夏季为9．99％（149／1491），秋季为9．71％（98／1009）。MP、CP夏季检出率最高，分别达31．27％（819／2619）和10．07％（43／427）。毛细支气管炎以RSV最多见[33．27％（866／2603）]；支气管肺炎和大叶性肺炎均以MP检出最多，检出率分别为26．05％（1152／4422）和52．25％（267／511）。结论MP、RSV是住院儿童呼吸道感染常见病原。新型病毒hMPV和HBoV在儿童呼吸道感染中也起着重要的作用。不同的病原，年龄分布不同，具有各自的季节性及疾病分布特点。

Objective To elucidate the etiology of acute respiratory tract infection （ARI） in hospitalized children in Suzhou from 2005 to 2011. Methods A total of 10 243 hospitalized children with ARI in Children＇s Hospital Affiliated to Soochow University from September 2005 to October 2011 were enrolled in the study. The clinical information was collected; and the nasopharyngeal aspiration fluid and serum samples were sent for multi-pathogen detection. Respiratory syncytial virus （ RSV ） , influenza virus type A and B （ IV-A, IV-B ）, parainfluenza virus type 1-3 （ PIV-1 - PIV-3 ） and adenovirus （ ADV ） were deteeted by direct immunofluoreseenee assay. Human bocavirus （ HBoV ） , mycoplasma pneumoniae （MP） and ehlamydia pneumoniae （CP） were detected by fluorescent quantitative PCR while human metapneumovirus （hMPV） was detected by reverse transcription PCR （RT-PCR）. Sputum culture was applied to detect bacterial infection and quantitative ELISA was adopted to detect the specific antibodies of MP and CP. The results of the above detections were analyzed, and thereby to explore the prevalent pathogens among different aging children and the seasonal distribution and characteristics of the disease. Results At least one type of pathogen was detected in 5871 out of 10 243 hospitalized children and the overall positive rate was 57.32%; including 3326 virus samples with positive rate at 32.47% （3326/10 243 ）, 2870 bacteria samples with positive rate at 28. 02% （2870/10 243） and 2759 atypical pathogen samples, with positive rate at 26. 94% （2759/10 243）. MP was the most common pathogen,whose detected rate was 25.74% （2637/10 243）. The median age of children with RSV （6 months） or PIV-3（8 months） infection was younger than the median age of all hospitalized children （ 12 months） （ χ2 = 380. 992,34. 826, P 〈 0. 05 ）. While the median age of children with ADV （42 months）, HBoV （ 14 months） or IV-A （24 months） infection was older than it of all hospitalized children （ χ2 = 83. 583,13. 169, 18. 012, P 〈 0. 05 ）. The median age of children with MP （ 30 months ） , streptococcus pneumoniae （ 17 months ） or haemophilus parainfluenzae （21 months） infection was older than it of all hospitalized children （ χ2 = 728. 299,60. 463, 8. 803,P 〈 0.05）. The detected rate of RSV in the groups of children aging less than 6 months, 7 - 12 months,2 - 3 years,4 - 5 years and over 6 years was separately 25.59% （840/3283） , 17.05% （333/1953） ,11.85% （310/2615） ,6. 68% （90/1347） ,and 2. 87% （30/1045） ; which decreased while the age grew （~2 = 178.46,P 〈 0.01 ）. Conversely, the positive rate of MP increased with the age growing （ X2 = 379.21 ,P 〈 0. 01 ）. The rate in the above groups was 8.25% （ 271/3283 ）, 19.46% （ 380/1953 ）, 33.00% （ 863/2615 ）, 41.43% （ 558/1347 ）, 54. 07% （ 565/1045 ）, respectively. RSV and IV-A were prevalent in winter, whose detected rates were 35.73% （941/2634） and 4.44% （117/2634） respectively, hMPV infection was common in spring,with the detected rate at 10. 55% （278/2634）; while HBoV infection was common in summer and autumn,with the positive rate at 9.99% （149/1491） and 9. 71% （98/1009）. MP and CP were frequently detected in summer, up to 31.27% （819/2619） and 10.07% （43/427） respectively. RSV was the most common pathogen in bronchiolitis （33.27% （866/2603）） and MP was the most common pathogen in bronchopneumonia （26. 05% （1152/4422） ） and lober pneumonia （52. 25 % （267/511 ） ）. Conclusion MP and RSV were the most common pathogens in respiratory tract infection in hospitalized children. The novel virus included hMPV and HBoV, which also played an important role in ARI. Different pathogens were prevalent in different ages; with respective seasonal distribution and characteristics.