儿童急性呼吸道感染的病毒病原学检测

Etiology of acute viral respiratory infections in children

目的了解广东省中山市博爱医院就诊患儿急性呼吸道感染(ARI)的病毒分离状况,为临床儿童ARI提供病毒病原学诊断依据。方法采集2011年12月—2012年11月在该院儿科门诊及住院诊治的ARI患儿鼻咽分泌物,用直接免疫荧光方法检测呼吸道合胞病毒(RSV)、腺病毒(ADV)、甲型流感病毒(IfuA)、乙型流感病毒(IfuB)及副流感病毒Ⅰ、Ⅱ、Ⅲ(ParaⅠ、Ⅱ、Ⅲ)型7种常见呼吸道病毒抗原,并对检测结果进行分析。结果 9 459例患儿中,病毒检测阳性2 429例,检出率为25.7%,其中RSV阳性1 104例(45.5%),IfuA阳性411例(16.9%),ParaⅢ阳性316例(13.0%),IfuB阳性290例(11.9%),ADV阳性275例(11.3%),ParaⅠ阳性29例(1.2%),ParaⅡ阳性4例(0.2%)。RSV感染主要在冬春季节好发。不同年龄段RSV阳性率差异有统计学意义;6岁以上患儿RSV所占比率明显低于6岁以下患儿。2种或以上病毒混合感染57例(2.3%),其中49例(84.2%)为2种病毒混合感染,9例(15.8%)为3种病毒混合感染。7种病毒中混合感染率最高的是RSV,最常见的类型是RSV和ParaⅢ,16例(28.1%)。结论 RSV是该院患儿ARI的主要病毒病原,RSV感染好发于冬春季,多见于1岁以下婴幼儿。RSV阳性率随着年龄的增长逐渐减低。ADV检测的阳性率为11.3%,高于国内外文献报道,可说明近年ADV感染在儿童ARI中可能有增多的趋势。

Objective To investigate the status of viral pathogens of acute respiratory infections in the children treated in Zhongshan BoAi Hospital.Methods A total of 9 459 nasopharyngeal secretion samples were collected from December 2011 to November 2012 in Zhongshan Boai Hospital.Direct immunefluorescence technique was used to detect seven common respiratory viruses,including respiratory syncytial virus（RSV）,adenovirus（ADV）,influenza virus A and B,parainfluenza virusⅠ,Ⅱ,Ⅲ.The prevalence of various viral infections were analyzed in terms of season,age,sex and geographical region.Results In9 459 cases of acute respiratory infections in children,viral pathogen was positive in 2 429（25.7%）cases,including RSV1 104（45.5%）,influenza virus A411（16.9%）,parainfluenza virusⅢ 316（13.0%）,influenza virus B290（11.9%）,ADV275（11.3%）,parainfluenza virusⅠ29（1.2%）,parainfluenza virusⅡ4（0.2%）.RSV infections occurred mainly in winter and spring.The prevalence of RSV infection varied significantly with age groups.The prevalence of RSV infections in children above 6 years of age was significantly lower than that in the children younger than6 years of age.Mixed infection with2 or more viruses was identified in 57 cases（2.3%）,of which 49（84.2%）infected with 2 viruses,9（15.8%）infected with 3 viruses.RSV was the most frequently isolated virus in the mixed viral infections.The most common pattern of mixed infection was RSV plus parainfluenza virusⅢ（16 cases,28.1%）.Conclusions RSV is the most important viral pathogen of acute respiratory infections in the children treated in Zhongshan Boai Hospital.RSV infection usually develops in winter and spring,especially in infants under one year of age.The prevalence of RSV reduces gradually with age.The prevalence of ADV is 11.3%,higher than previously reported data at home and abroad.This may suggest the increasing prevalence of ADV in the children with acute respiratory infections in recent years.