婴幼儿急性下呼吸道感染的病毒病原学分析

Viral etiology analysis of acute lower respiratory infections in infants

目的探讨本地区引起儿童急性下呼吸道感染(ALRI)的病毒病原学特点。方法 2010年1月—2011年1月在泸州医学院附属医院儿科住院患儿545例,符合ALRI诊断标准,采用ELISA法分别检测患儿急性期血清中呼吸道合胞病毒(RSV)、腺病毒(ADV),甲型流感病毒(IFVA)、乙型流感病毒(IFVB)和副流感病毒(PIV1、PIV2、PIV3)特异性IgM;用速率散射比浊法测定C-反应蛋白(CRP)和免疫球蛋白。用碱性磷酸酶标记链霉卵白素(S-A/AP)法检测人外周血T淋巴细胞亚群。结果 545例ALRI中共检出病毒感染258例,病毒感染率47.3%,单一病毒感染184例(71.3%),其中RSV57例(22.1%),ADV41例(16.1%),IFVA23例(8.9%),IFVB29例(11.3%),PIV(1、2、3)33例(12.8.2%),混和病毒感染共65例(29.1%),以IFV+PIV27例(10.4%)多见。1个月、12个月、3岁三个年龄组病毒性肺炎患儿血清lgG、lgA、lgM与对照组比较,均无显著性差异(P>0.05);而T细胞亚群与对照组比较,CD3↓、CD4↓、CD4/CD8↓、CD8↑,均有显著差异(P<0.05)。结论病毒感染是婴幼ALRI的主要病原,血清病毒特异性IgM对于婴幼儿ALRI的早期快速诊断有一定的应用价值。细胞免疫功能紊乱在小儿病毒性肺炎发病机制中起重要作用。

Objective To explore etiology of infant community acute lower respiratory infections （ALRI）. Methods Five common viral specific serum IgM antibodies were detected by enzyme-linked immunosorbent assay （ELISA）from 545 cases of ALRI blood. C-reactive protein （CRP）, IgG, IgA, IgM were detected by rate scattered nephelometry.T Lymphocyte subpopulation was detected by Streptavidin-alkaline phosphatase （S-A/AP）. The compared group was local healthy infant in the same time and same age-stage. Results 258 viral cases were detected from 545 cases ofi ALRI, the viral infection rate was 47.3 %.There were 184 （71.3%） single viral infection cases,among them RSV： 57 cases （22.1%）, ADV41 （16.1%）, IFVA 23 （8.9%）, IFVB 29 （11.3%）, PIV （1, 2, 3） 33 （12.8.2%） ; there were 65 （29.1%）mixed viral infection cases, among them IFV＋PIV： 27 cases （10.4%）, and they were the first. There were not significant difference between three age-stage group （1 month -12month,-36month） of viral pneumonia and compared group （all P 〉 0.05） ; there were significant defference in T lymphocyte subpopulation between viral pneumonia group and compared group （all P 〈 0.05）, corcretely display CD3, CD4, CD/CD8 all decline, but CD8 rise up in the viral group. Conclusion Viral infection was the main pathogenesis of infant community acute lower respiratory infections （ALRI）. Viral specific serum IgM antibody detection was of value in early and rapid etiological diagnosis of pediatric. Cellular immunity disturbance was the main mechanism of infant viral pemeumonia＇ s invasion.