儿童社区获得性肺炎中人腺病毒感染的多中心研究

Multicenter study of human adenovirus infection in pediatric community-acquired pneumonia in China

目的了解我国儿童社区获得性肺炎(CAP)中人腺病毒(HAdV)的优势基因型别和流行特征。方法横断面研究,采集2014年11月—2016年11月我国北方和南方12家医院临床诊断为CAP的住院患儿鼻咽抽吸物(NPAs)或咽拭子1份,应用Luminex公司的液相悬浮芯片技术筛查包括HAdV在内的18种常见呼吸道病毒。对HAdV阳性标本进行基因分型及基本流行病学及临床特征分析。结果(1)本研究共纳入2723例CAP患儿,检测出HAdV阳性标本156例(5.7%,156/2723),其中北方74例(6.6%,74/1128),南方82例(5.1%,82/1595),南北方阳性检出率差异无统计学意义(P>0.05)。(2)我国北方<6月龄组、6月龄~<1岁年龄组、1~<3岁年龄组、3~<5岁年龄组和≥5岁年龄组的HAdV检出率分别为5.9%(6/101),6.7%(7/104),10.3%(34/331),4.1%(11/266)和4.9%(16/326),1~3岁年龄组HAdV检出率最高(χ^2=11.511,P=0.021);南方<6月龄组、6月龄~<1岁年龄组、1~<3岁年龄组、3~<5岁年龄组和≥5岁年龄组的HAdV检出率分别为2.2%(7/312),4.6%(12/259),6.3%(31/494),7.3%(18/245)和4.9%(14/285),各年龄组差异无统计学意义(P>0.05)。(3)2015年我国北方冬季HAdV检出率最高为12.5%(25/200),南方地区在春季和夏季HAdV检出率最高,分别为春季6.7%(35/525),夏季5.3%(19/357)。(4)对108例HAdV阳性标本进行分型,分型成功80例,其中3型32例,7型9例,1型12例,2型15例,5型10例,6型1例,4型1例。我国北方地区流行的优势型别为HAdV-B组HAdV-3(30.8%,8/26)和HAdV-7(26.9%,7/26),而南方地区流行的优势型别为HAdV-B组HAdV-3(44.4%,24/54)和HAdV-C组HAdV-2(22.2%,12/54)。结论HAdV是儿童CAP的重要病毒病原,北方和南方流行的优势型别和感染高发季节存在差异,北方地区流行的优势型别为HAdV-3和HAdV-7,南方地区流行的优势型别为HAdV-3和HAdV-2,北方地区冬季为HAdV感染的高发季节,南方地区春季和夏季为HAdV感染的高发季节。

Objective To investigate the predominant genotypes and epidemiological characteristics of human adenovirus(HAdV)in pediatric community-acquired pneumonia(CAP)in China.Methods This was a repeated cross sectional study.Between November 2014 and November 2016,nasopharyngeal aspirates(NPAs)or throat swabs from each hospitalized pediatric patients diagnosed as CAP in 12 hospitals in Northern and Southern China were collected.Respiratory specimens were screened for 18 respiratory viruses including HAdV by using Luminex xTAG RVP Fast V2 multiplex Assay.Typing of HAdV and analysis for the epidemiological characteristic of HAdV were performed.Results(1)A total of 2 723 hospitalized pediatric patients with CAP were enrolled in this study and 156(5.7%,156/2 723)respiratory specimens were positive for HAdV,and 74(6.6%,74/1 128)and 82(5.1%,82/1 595)were in Northern and Southern China,respectively.There was no significant difference in the positive detection rate between the Northern and Southern China.(2)In Northern China,the HAdV positive rate of children at the age of <6 months,6 months-<1 years,1-<3 years,3-<5 years and≥5 years was 5.9%(6/101),6.7%(7/104),10.3%(34/331),4.1%(11/266)and 4.9%(16/326),respectively,and the incidence of HAdV infection peaked in children aged 1-3 years(χ^2=11.511,P=0.021).While in Southern China the HAdV positive rate of children at the age of <6 months,6 months-<1 years,1-<3 years,3-<5 years and≥5 years was 2.2%(7/312),4.6%(12/259),6.3%(31/494),7.3%(18/245)and 4.9%(14/285),respectively.There was no significant difference in the positive detection rate among age groups.(3)In 2015,the highest detection rate of HAdV in northern China was 12.5%(25/200)in winter,and in Southern China was 6.7%(35/525)in spring and 5.3%(19/357)in summer.(4)In 108 cases of HAdV positive specimens typing was done and 80 in cases classification was successfully performed.Totally 7 genotypes of HAdV,including HAdV-3(n=32),HAdV-7(n=9),HAdV-1(n=12),HAdV-2(n=15),HAdV-5(n=10),HAdV-6(n=1)and HAdV-4(n=1),were detected.The predominant HAdV genotypes were HAdV-3(30.8%,8/26)and HAdV-7(26.9%,7/26)in Northern China,while HAdV-3(44.4%,24/54)and HAdV-2(22.2%,12/54)were the most prevalent genotypes in Southern China.Conclusions HAdV is an important viral pathogen in pediatric CAP.The predominant HAdV genotypes and peak seasons of HAdV infections were different between Northern and Southern China.The predominant HAdV genotypes were HAdV-3 and HAdV-7 in Northern China,while HAdV-3 and HAdV-2 in Southern China.The peak season of HAdV infections was winter in Northern China.However,HAdV infections are more common in spring and summer in Southern China.