小儿急性下呼吸道病毒感染的临床流行病学特征

Clinical epidemiologic features of acute lower respiratory virus infections in children

目的了解小儿呼吸道病毒感染的临床流行病学特征。方法采集浙江大学金华医院儿科2012年5月至2013年4月诊断为急性下呼吸道感染（ALRTI）的560例患儿的鼻咽拭子样本进行直接荧光法检测7种呼吸道病毒（呼吸道合胞病毒、流感病毒A型及B型、副流感病毒Ⅰ、Ⅱ、Ⅲ型、腺病毒），比较不同季节、年龄、性别、疾病类型患儿呼吸道病毒阳性检出率的差异，连续监测56例病毒检出患儿治疗过程中的病毒感染状况。结果560例ALRTI患儿中，呼吸道病毒阳性138例，阳性率24．64％．其中单一病毒检出率为23．21％，混合感染检出率为1.43％。不同季节、年龄组和疾病类型的病毒阳性检出率差异有统计学意义（χ2=43．76、24．98、97．60．P〈0．01），其中冬春季节发病、1岁以内、支气管哮喘发作和毛细支气管炎患儿的病毒阳性检出率较高。56例患儿治疗后病毒检出下降，但直至出院时，仍有9例能够检出病毒。结论小儿下呼吸道感染的病毒检出率较低，以呼吸道合胞病毒单一感染为主，冬春季节、1岁以下幼儿及支气管哮喘和毛细支气管炎患儿病毒检出率较高，部分患儿经治疗后病毒转阴较慢。

Objective To explore the clinical epidemiologic features of respiratory virus infections in children. Methods There were 560 specimens of nasopharyngeal swabs from acute lower respiratory virus infection （ALRTI） patients from May, 2012 to April, 2013 to detect seven kinds of respiratory viruses（respiratory syneytial virus, influenza virus type A and type B, parainfluenza virus type 1, 2, 3 and adenovirus） by direct fluorescence assay. Meanwhile, the relationships between respiratory virus detection rate with different seasons, ages, genders, diseases were analyzed and 56 cases of respiratory virus-positive were monitored dynamically. Results There were 138 cases of respiratory virus-positive in all 560 cases of children patients with ALRTI, and the positive rate was 24.64%, of which the single virus detection rate was 23.21% and the mixed variety of virus detection rate was 1.43%. There were significant differences in the positive rate of respiratory viruses in different seasons, ages, diseases （χ2=43.76, 24.98, 97.60, P all 〈0.01 ）. In winter and spring seasons, children younger than one year old, and patients with bronchial asthma and bronchiolitis showed higher positive detection rate than others. The positive rate of respiratory virus of 56 cases decreased significantly after treatment. However, the respiratory virus could still be detected in 9 cases. Conclusions The positive rate of acute lower respiratory infections is comparatively low, which is mainly single infection of respiratory syneytial viruses. The positive rate is high in winter and spring, children younger than one year old, and patients with bronchial asthma and bronehiolitis. Some children have slower virus clearance after treatment.