门诊发热患者秋冬季呼吸道病毒感染的病原学分布与快速诊断

Etiological analysis and rapid diagnosis of respiratory tract viral infections in outpatients with fever in autumn and winter

目的：了解门诊发热患者秋冬季呼吸道病毒感染的病原构成，建立门诊发热患者呼吸道病毒的快速诊断方法，提高呼吸道传染病病原快速检测能力。方法收集医院2013年11月－2014年1月205例患者咽拭子，采用荧光定量RT‐PCR法对流感病毒、副流感病毒、呼吸道合胞病毒、人冠状病毒、人偏肺病毒、腺病毒、人博卡病毒和鼻病毒等进行核酸检测。结果205份标本中有70份标本病毒阳性，阳性检出率为34．1％；病毒阳性标本中，流感病毒检出率最高，以甲型流感病毒为主、鼻病毒位居第2、冠状病毒位居第3；5份标本检出两种病毒混合感染，以冠状病毒混合感染为主；性别与病毒检出差异无统计学意义；75～89岁患者病毒检出率最高为57．1％，乙型流感病毒在不同年龄段感染差异有统计学意义（P＜0．05）；各种病毒引起的上呼吸道感染和肺炎差异均无统计学意义；患者体温37～37．9℃时病毒检出率最高。结论甲型流感病毒是秋冬季引起呼吸道感染的主要病原体，荧光定量RT‐PCR可快速明确呼吸道感染病毒。

OBJECTIVE To understand the etiological distribution of respiratory tract viral infections in the outpa‐tients with fever in autumn and winter so as to establish rapid diagnosis method and improve the ability of rapid de‐tection of pathogens causing respiratory tract infectious diseases .METHODS The throat swabs were collected from 205 patients who were admitted to the hospital from Nov 2013 to Jan 2014 ,then the fluorescence quantitative real‐time PCR was used to detect the influenza virus （IV） ,parainfluenza virus （PIV） ,respiratory syncytial virus （RSV） ,human coronavirus （HCoV） ,human metapneumovirus （HMPV） ,adenovirus（ADV） ,human Boka virus （HBoV） ,and rhinovirus （RV） .RESULTS Of the 205 specimens ,70 were detected positive for viruses ,with the positive rate of 34 .1% ;among the positive specimens ,the isolation rate of influenza virus was the highest ,domi‐nated by the influenza A virus ,the rhinovirus ranked the second place ,and the coronavirus ranked the third place . The mixed infections with two species of viruses were detected in 5 specimens ,and the mixed infections with coro‐navirus were dominant .There was no difference between the genders and the isolation of viruses .The isolation rate of viruses was the highest （57 .1% ） among the patients aged between 75 and 89 years old ,and there was differ‐ence in the isolation rate of influenza B virus among the various age groups （P〈0 .05） .There was no difference in the upper respiratory tract infections or pneumonia induced by the viruses .The isolation rate of viruses was the highest among the patients with the body temperature ranging between 37 and 37 .9 ℃ .CONCLUSION The influ‐enza A virus is the predominant species of pathogen causing the respiratory tract infections in autumn and winter , and the fluorescence quantitative RT‐PCR can quickly identify the viruses causing the respiratory tract infections .