2007-2015年北京地区儿童急性下呼吸道感染人冠状病毒检测及临床分析

Detection and clinical analysis of acute lower respiratory tract infection with human coronaviruses in children in Beijing area 2007-2015

目的 了解北京地区儿童急性下呼吸道感染（ALRTI）中人冠状病毒（HCoV）的感染情况,了解儿童急性下呼吸道HCoV感染的临床特征.方法 2007年3月至2015年2月首都医科大学附属北京儿童医院内科急救室就诊及住院的急性下呼吸道感染患儿共4 371例,按年龄分为4组,其中＜1岁组1 890例;1～＜3岁组788例;3～＜6岁组553例;≥6岁组1 140例.采用RT-PCR方法,对患儿鼻咽吸取物进行HCoV（包括HCoV-OC43,HCoV-229E,HCoV-NL63和HCoV-HKU1）及RSV等9种常见呼吸道病毒检测.对单纯HCoV阳性住院病例的临床表现进行分析,并与同期单纯呼吸道合胞病毒感染住院病例的临床特征进行对比.结果 （1）在总共4 371例ALRTI患儿中,病毒阳性2 895例（66.23％）,其中HCoV阳性147例（检出率3.36％）.（2）2007-2014年各年份HCoV的检出率（％）分别为：6.11、3.79、4.69、4.31、2.38、2.10、0.77和2.65;1-12月各月HCoV的检出率（％）依次为2.53、2.12、3.63、6.68、1.53、3.77、3.92、3.00、2.15、5.26、3.叭和2.80.（3）不同种HCoV在4 371例ALRTI患儿中的检出情况如下：HCoV-OC43阳性48例（1.10％）,HCoV-229E阳性32例（0.73％）,HCoV-NL63阳性25例（0.57％）,HCoV-HKU1阳性27例（0.62％）.（4）＜1岁、1～＜3岁、3～＜6岁和≥6岁年龄组HCoV的检出率分别为4.13％、5.08％、2.71％和1.23％（x2 =27.218,P＜0.01）.（5）单纯HCoV急性下呼吸道感染住院患儿共16例,其中支气管肺炎12例,急性喉梗阻3例,支气管哮喘急性发作2例.常见临床表现为咳嗽（14例）、喘息（13例）、呼吸困难（9例）、发热（6例）、声嘶（4例）、喉鸣（4例）,胸X线片异常（包括肺纹理增粗模糊、斑片影或致密影）（12例）.其临床表现、并发症的发生率以及接受机械通气的比例,与同期193例单纯RSV感染患儿差异无统计学意义.结论 2007年3月至2015年2月北京地区HCoV检出率为3.36％;单纯HCoV急性下呼吸道感染住院患儿临床表现及病情严重程度与单纯呼吸道合胞病毒感染者相似.

Objective To investigate human coronaviruses （HCoVs） infection in children with acute lower respiratory tract infection （ALRTI） and to explore the clinical features of ALRTI caused by HCoVs in children.Method Totally 4 371 children with clinical diagnosis of ALRTI during the period from March 2007 to February 2015 seen in Beijing Children＆#39;s Hospital were recruited into this study.Patients were divided into 4 groups by age,including 1 890 cases in 〈 1 year group,788 cases in 1-3 years group,553 cases in 3-6 years group,1140 cases in ≥6 years group.One nasopharyngeal aspirate specimen was collected from each patient.RT-PCR methods were applied to detect 9 common respiratory viruses including HCoVs （including HCoV-OC43,HCoV-229E,HCoV-NL63 and HCoV-HKU1）,respiratory syncytial virus （RSV） and so on.Clinical features of ALRTI with single HCoVs infection were analyzed and compared with hospitalized ALRTI cases with single RSV infection in the same period.Result （1） Totally 2 895 cases were positive for at least one virus in this study in 4 371 ALRTI patients （positive rate 66.23%）,in which 147 cases were positive for HCoVs infection （positive rate 3.36%）.（2） Positive rates of HCoVs in each year from 2007 to 2014 were 6.11%,3.79%,4.69%,4.31%,2.38% 2.10%,0.77% and 2.65%,respectively.The mean positive rates of HCoVs for each month from January to December were 2.53%,2.12%,3.63%,6.68%,1.53%,3.77%,3.92%,3.00%,2.15%,5.26%,3.01% and 2.80%.（3） Detection results of each subtypes of HCoVs in total 4 371 pediatric ALRTI patients were：48 cases positive for HCoV-OC43 （1.10%）,32 cases positive for HCoV-229E （0.73%）,25 cases positive for HCoV-NL63（0.57%）,27 cases positive for HCoV-HKU1 （0.62%）.（4） Positive rates of HCoVs infection in 〈 1 year group,1-3 years group,3-6 years group and≥6 years group were 4.13%,5.08%,2.71% and 1.23%,respectively.There were significant differences in positive rates of HCoV among groups （x2 =27.218,P 〈0.01）.（5） There were 16 hospitalized cases with single infection of HCoVs in this study,of which 12 cases were diagnosed as bronchopneumonia,3 cases developed acute laryngeal obstruction,2 cases had acute bronchial asthma attack.Common clinical manifestations included cough （14 cases）,gasping （13 cases）,dyspnea （9 cases）,fever （6 cases）,hoarseness （4 cases）,laryngeal stridor （4 cases） and abnormality on chest X-ray（including fuzzy lung texture,patchy shadow and consolidation） （12 cases）.（6） There were no significant differences in the incidence of clinical manifestations （including cough,gasping,dyspnea,fever and abnormality on chest X-ray）,complications （including respiratory failure,myocardial damage,and acute bronchial asthma attack） and mechanical ventilation between hospitalized ALRTI patients with single HCoV infection and 193 patients with single RSV infection in the same period.Conclusion HCoVs are pathogens of ALRTI in children,The overall positive rate of HCoVs was 3.36% in this study.The clinical manifestations and severity of ALRTI caused by single HCoVs was comparable to that of ALRTI with single RSV infection in children.