湖北地区儿童呼吸道病原体的流行病学分析

Epidemiological analysis on pathogens of respiratory tract infections in children in Hubei Province

目的了解湖北地区儿童常见呼吸道感染的病原体特点和流行趋势,分析该地区小儿呼吸道感染病原体与年龄、性别和季节的相关性,为有关部门制定呼吸道感染疾病预防控制决策提供参考资料。方法收集武汉大学人民医院2013年1月1日—2014年12月31日两年间呼吸道感染的儿童患者12 914名,采用间接免疫荧光法检（IFA）测血清中嗜肺军团菌（LP）、肺炎支原体（MP）、Q热立克次体（COX）、肺炎衣原体（CP）、腺病毒（ADV）、呼吸道合胞病毒（RSV）、甲型流感病毒（Flu A）、乙型流感病毒（Flu B）和副流感病毒（PIV）的Ig M抗体。结果在12 914例呼吸道感染的患儿中,病原体检测阳性患儿共5 381例,阳性率为41.67%。其中单一感染3 508例,占65.1%;混合感染1 873例,占34.8%。男性患儿阳性率（37.5%）低于女性患儿（49.10%）,差异有统计学意义（χ^2=163.20,P〈0.01）。从2013—2014年单一病原体感染率显著下降（从29.58%到25.00%）,差异有统计学意义（χ^2=34.13,P〈0.01）。混合病原体感染率显著上升（从10.22%到18.35%）,差异有统计学意义（χ^2=171.44,P〈0.01）。MP阳性率最高为38.8%,在3-6岁幼儿中易感;Flu B阳性率为29.5%,在3-6岁儿童中易感,两者均好发于秋、冬两季。RSV阳性率为4.0%,在0-1岁婴儿中易感,好发于春季。ADV阳性率为3.65%,PIV阳性率为2.3%,在3-6岁儿童中易感,好发于夏季。Flu A阳性率为1.29%,在3-6岁儿童中易感,好发于秋季。LP阳性率为0.6%,在6-14岁儿童中易感,全年发病。COX和CP感染例数太少,未进行分析。结论 MP和Flu B是湖北地区小儿急性呼吸道感染的主要病原体。呼吸道病原体感染模式以单一感染为主,混合感染逐年升高;在呼吸道病毒的易感年龄段和高发的季节,应针对性地加强防范。

[Objective]To learn the epidemic characteristics and trends of pathogens of the common respiratory tract infections in children in Hubei Province, analyze the correlations between pathogens of child respiratory tract infections and age, sex, season,and provide the reference data for the relevant departments to formulate the prevention and control measures against respiratory tract infection diseases.[Methods]12 914 children patients with respiratory tract infections were collected from Renmin Hospital of Wuhan University from January 1, 2013 to December 31, 2014. The indirect immunofluorescence assay（ IFA） was used to detect the serum Ig M antibodies of Legionella pneumophila（ LP）, Mycoplasma pneumonia（ MP）, Coxiella burnetii（ COX）, Chlamydia pneumoniae（ CP）, Adenovirus vector（ ADV）, Respiratory syncytial virus（ RSV）, Influenza A virus（ Flu A）, Influenza B virus（ Flu B） and Parainfluenza virus（ PIV）.[Results]In 12 914 children patients with respiratory tract infections, the pathogens were detected in 5381 patients with the positive rate of 41.67%. There were 3 508 cases of single infection and 1 873 cases of mixed infection, which accounted for 65.1% and 34.8% respectively. The positive rate of male children（ 37.5%） was lower than that of female children（ 49.10%）, and the difference was statistically significant（ χ^2=163.20,P〈0.01）. The rate of single pathogen infection significantly decreased from 29.58% in 2013 to 25.00% in 2014（ χ^2=34.13,P〈0.01）. The rate of mixed pathogen infection significantly increased from 10.22% in 2013 to 18.35% in 2014（ χ^2=171.44,P0.01）. The positive rate of MP and Flu B was 38.8% and 29.5% respectively, both of them showed the higher susceptibility in children aged 3-6 years old, and the peak season occurred in the autumn and winter. The positive rate of RSV was 4.0%, which showed the higher susceptibility in children aged 0-1year old, and the peak season occurred in the spring. The positive rate of ADV and PIV was 29.5% and 2.3%respectively, which showed the higher susceptibility in children aged 3-6 years old, and the peak season appeared in the summer. The positive rate of Flu A was 1.29%, which showed the higher susceptibility in children aged 3-6 years old, and the peak season occurred in the autumn. The positive rate of LP was 0.6%, which showed the higher susceptibility in children aged6-14 years old, and the cases occurred throughout the year. However, due to the smaller quantity of COX and CP infections cases, the analysis has not been carried out. [Conclusion]MP and Flu B are the major pathogens of acute respiratory tract infections in children in Hubei Province. The infection mode is dominated by the single pathogen infection, while the proportion of mixed infection is increasing year by year. It is necessary to strengthen the targeted prevention and control in high-risk populations and peak seasons.