6月龄以下住院肺炎患儿巨细胞病毒的检测及临床特点分析

Cytomegalovirus detection of hospitalized pneumonia infants who under six- month old and clinical characteristics analysis

目的：探讨济宁地区6月龄以下住院肺炎患儿巨细胞病毒（CMV）感染情况及临床特点。方法：研究对象为2010年1月～2012年12月临床诊断为肺炎的住院患儿。采用酶联免疫斑点技术对6月龄以下住院肺炎患儿血清进行CMV-IgM抗体检测。结果：848例肺炎患儿中，137例CMV-IgM抗体阳性，感染率16.16%；男女感染率分别为17.11%和13.75%，差异无统计学意义（χ^2=1.43，P =0.23）。0～1个月、1～3个月、3～5个月和5～6个月年龄组感染率分别为9.57%、28.16%、11.17%和10.89%；1～3个月年龄组CMV感染率明显高于其它各年龄组（χ^2=43.99，P＜0.01）。春、夏、秋、冬季CMV感染率分别为14.19%、12.23%、13.30%和20.11%，差异无统计学意义（χ^2=7.36，P =0.061）；但冬季CMV感染例数占总感染例数的52.55%，冬季相对较多。137例CMV感染患儿中，＜2周2例（1.46%），3～12周103例（75.18%），＞12周32例（23.36%），以围生期感染居多；母乳喂养120例，其中足月儿105例（87.50%），早产儿15例（12.50%），哺乳期足月儿CMV感染占有相当大的比例。婴儿巨细胞病毒肺炎常出现咳嗽、气促、喘息、肺部啰音以及发热等症状、体征，肺CT影像学诊断的敏感度优于X线检查。结论：CMV是引起6月龄以下婴儿肺炎的重要病原体，1～3月龄的婴儿为易感人群。婴儿 CM V 肺炎临床表现缺乏特异性，血清 CMV-IgM 抗体阳性是 CMV肺炎的实验室诊断依据，影像学诊断主要依靠肺 CT。

Objective：To explore the clinical characteristics of cytomegalovirus （CMV） infection in hospitalized infants under 6 months with pneumonia in Jining area.Methods：Eight hundred forty-eight hospitalized infants under 6 months of age with pneumonia from January 2010 to December 2012, were enrolled in our study. Serum samples were detected for CMV-IgM by ELISPOTS.Results：One hundred thirty-seven （16.16 %） were positive for CMV-IgM in 848 cases. There was no significant difference of infection rates between male （17. 11%） and female （13.75%） （χ2 =1.43,P =0.23）. The infection rates of 0-1 month old, 1-3 months old, 3-5 months old and 5-6 months old were 9.57%, 28.16%, 11.17% and 10.89%, respectively. Furthermore, the age group analysis of CMV positive children with pneumonia manifested a significant increase in the infection rate among the age group of 1-3 months（χ2 =43.99,P〈0.01）. The rates of CMV infection were 14.19% in the spring, 12.23%, in summer, 13.30% in autumn and 20.11% in winter, with no significant difference of infection rates among seasons （χ2 =7.36,P =0.061）, but the cases of infection during winter accounted for 52.55% of the total infected cases. Of the 137 infant patients with CMV infection, 2 cases（1.46%）were 〈 2 weeks of age , while 103 cases（75.18%） were between 3 and 12 weeks of age, and 32 cases（23.36%）were〉12 weeks of age. The proportion of full-term infants breastfed was 87.50% and the one of premature infants breastfed was 12.50% in 120 cases of CMV infection. Most of the patients appear cough, short breath, rale and fever. The sensitivity of lung CT to diagnose the pneumonia was superior to chest X-ray.Conclusions：CMV was the most important viral pathogens on pneumonia in infants under 6months. Infants aged 1-3 months were susceptible to CMV infection. Clinical manifestations of infant CMV pneumonia lack specificity. The presence of serum CMV-IgM antibody is a laboratory diagnostic evidence. The iconographic diagnosis of CMV pneumonia was mainly based on lung CT.