255例急性下呼吸道感染并血小板异常患儿病毒病原学分析

Viral etiology in children with acute lower respiratory tract infections plus platelet disorders in Changsha, China: an analysis of 255 cases

目的了解住院患儿急性下呼吸道感染(ALRTI)并血小板异常的病毒病原学情况。方法收集2010年3月至2011年2月255例血小板异常及同期442例血小板正常的ALRTI住院患儿鼻咽抽吸物样本,采用RT-PCR或PCR方法进行14种病毒检测。结果 255例血小板异常并ALRTI患儿中,血小板增多253例(99.2%),血小板减少2例(0.8%)。血小板异常组中检出至少有1种病毒感染173例(67.8%),其中,人鼻病毒(HRV)检出率最高,其次是副流感病毒3(PIV3)和呼吸道合胞病毒(RSV)。与血小板正常组相比较,血小板异常组PIV3检出率显著增高(P<0.05),而流感病毒B(IFVB)检出率则显著降低(P<0.05)。血小板异常组和血小板正常组的年龄分布差异有统计学意义(P<0.01),其中1岁以下年龄段血小板异常最显著(P<0.01)。结论 ALRTI时易引起血小板增多,尤其是PIV3感染者,而IFVB感染则不易引起血小板的变化。小于1岁的ALRTI住院患儿更易出现血小板异常。

Objective To investigate the viral etiology in hospitalized chitdren with acute lower respiratory tract infections （ALRTI） plus platelet disorders. Methods A total of 255 children with ALRTI plus platelet disorders and 442 children with ALRTI and normal platelets, all of whom were hospitalized between March 2010 and February 2011, were included in the study. Their nasopharyngeal aspirate samples were collected, and RT-PCR or PCR was performed to detect 14 viruses. Results Of 255 ALRTI patients with platelet disorders, thrombocytosis was found in 253 cases （99.2%） and thrombocytopenia in 2 cases （0.8%）. Among ALRTI patients with platelet disorders, 173 （67.8%） were infected with at least one virus, with human rhinovirus as the most common one, followed by parainfluenza virus type 3 （PIV3） and respiratory syncytial virus （RSV）. The detection rate of PIV3 in the abnormal platelet group was significantly higher than in the normal platelet group （P〈0.05）. In contrast, the detection rate of influenza virus B （IFVB） in the abonormal platelet group was significantly lower than in the normal platelet group （P〈0.05）. The age distribution showed significant difference between the abnormal and normal platelet groups （P〈0.01）. Platelet disorders were mainly found in children under one year of age （P〈0.01）. Conclusions Thrombocytosis is often found in children with ALRTI caused by viruses, especially PIV3, but infection with IFVB seldom causes platelet disorders. Hospitalized children with ALRTI under one year tend to develop platelet disorders.