广州地区儿童呼吸道合胞病毒与肺炎支原体流行病学分析

Epidemiology and clinical presentation of respiratory syncytial virus and Mycoplasma pneumoniae infection in children in Guangzhou

目的监测广州地区急性呼吸道疾病患儿呼吸道合胞病毒（RSV）与肺炎支原体（MP）流行情况，分析RSV与MP在广州地区的流行特征，为广州地区RSV与MP的监控和防治提供参考。方法采集2012年1月至2014年1月在广州地区急性呼吸道疾病患儿（≤14岁）咽拭子标本，提取标本核酸，利用荧光定量PCR进行RSV与MP检测；并对其流行特征进行分析。结果在3760例患儿中，检出RSV392例，阳性率为10．4％；检出MP339例，阳性率9．0％。在RSV阳性病例中，年龄在0—9个月患儿最高，达19．6％（181／923例）。RSV流行高峰发生于2012年2月至4月和2013年1月至4月，阳性率分别为26．8％（136／507例）和18．0％（151／839例）。在MP阳性病例中，年龄在6-10岁阳性率最高，达20．1％（97／484例），MP流行高峰发生在2012年7月至10月和2013年6月至10月，阳性率分别为16．3％（92／564例）和13．4％（124／922例）。在上呼吸道症状中，RSV感染患儿鼻塞[28．6％（112／392例）]、流涕[33．2％（130／392例）]发生率显著高于MP阳性患儿[15．0％（51／339例）、20．6％（70／339例）]，2组比较差异均有统计学意义（χ^2=19．199、14．325，P均〈0．001）；RSV感染患儿咳嗽[78．1％（306／392例）]、咳痰[20．4％（80／392例）]发生率显著低于MP阳性患儿[90．0％（305／339例）、27．1％（92／339例）]，2组比较差异均有统计学意义（r=18．791、4．577，P〈0．001，P=0．032）。在下呼吸道症状中，RSV阳性患儿气喘[33．2％（130／392例）]、气促[13．5％（53／392例）]、喘鸣音[29．3％（115／392例）]、痰鸣音[18．9％（74／392例）]发生率显著高于MP阳性患儿[11．5％（39／339例）、6．5％（22／339例）、11．5％（39／339例）、10．6％（36／339例）]，2组比较差异均有统计学意义（χ^2=47．979、9．760、34．763、9．698，P〈0．001，P=0．002，P〈0．001，P=0．002）。MP阳性患儿双肺呼吸音粗[59．2％（201／339例）]较RSV阳性患儿[40．1％（157／392例）]更为多见，2组比较差异有统计学意义（χ^2=26．932，P〈0．001）。结论广州地区RSV的主要感染人群是0～9个月的儿童，重点在每年1月至4月；MP的主要感染人群是6—10岁的儿童，重点在每年6月至10月。预防工作要全年进行，预防因RSV和MP感染导致的住院率增高。

Objective To analyze the epidemiology and clinical presentation of respiratory syncytial virus （RSV） and Mycoplasma pneumoniae （MP） infection in Guangzhou district and to provide valuable data for the control and prevention of infectious disease, and to investigate RSV and MP manifestations in children with acute respiratory tract illness （ARTI）. Methods Throat swabs were collected from children （ ≤ 14 years old） with ARTI in Guangzhou from January 2012 to January 2014. Nucleic acid was extracted and tested in RSV and MP samples by real - time PCR. Clinical presentations of the patients were recorded for further analysis. Results Of 3 760 patients tested,392 cases were RSV positive （ 10.4% ）, and 339 cases were MP positive （9.0%）. In RSV - infection pediatric patients, the peak positivity rate of RSV[ 19.6% （ 181/923 cases） ] was found in patients at the age of less than 9 months. Monthly peak of RSV infection occurred from February to April 2012 [ 26.8% （136/507 cases） ] and from January to April 2013 [ 18.0% （ 151/839 ） ], respectively. In MP - positive patients, the peak positivity rate [ 20.1% （97/484 cases） ] was detected from pediatric patients at the age of 6 to 10 years old. Monthly peak of MP infection occurred from July to October 2012 [ 16.3% （92/564 cases） ] and from June to October 2013 [ 13.4% （ 124/922 cases） ], respectively. More nasal obstruction [ 28.6% （ 112/392 cases） ] and sneezing [ 33.2% （ 130/392 cases） ] presented in RSV - positive patients than those in MP - positive patients [ 15.0% （51/339 cases） ,20.6% （70/339 cases） ] in the upper respiratory tract illness, and there were significant differences （χ^2 = 19. 199, 14. 325, all P 〈 0. 001 ）. Less cough [78. 1% （306/392 cases）] and expectoration [20.4% （80/392 cases）]presented in RSV- positive patients than those in MP - positive patients [ 90.0% （ 305/339 cases ）, 27. 1% （ 92/339 cases） ] in the upper respiratory tract illness, and there were significant differences （χ^2 = 18. 791,4. 577, P 〈 0. 001, P = 0. 032）. More wheezing [ 33.2% （130/392 cases） ], shortness of breath [ 13.5% （53/392 cases） ], wheeze rale [ 29.3% （ 115/392 cases） ], and phlegm rale [ 18.9% （74/ 392 cases）] presented in RSV -positive patients than those in MP- positive patients [11.5% （39/339 cases） ,6.5% （22/339 cases）, 11.5% （39/ 339 cases）, 10.6% （36/ 339 cases） ] in the low respiratory tract, and there were significant differences （χ^2 = 47. 979,9. 760,34. 763,9. 698, P 〈 0. 001, P = 0. 002, P 〈0. 001 ,P =0.002）. More Sound coarse[59. 2% （201/399 cases）] presented in MP- positive patients than that in RSV- positive patients [40. 1% （157/392 cases）] in the low respiratory tract illness, and there was significant difference （χ^2 = 26. 932,P 〈 0.001 ）. Conclusions RSV infection is mostly found in patients less than 9 months from January to April each year and MP is mostly detected in children at the age of 6 to 10 years old in June to October each year in Guangzhou, and more attention should be paid. However, control and prevention of infection should be conducted all the year round to decrease the hospitalization rate caused by RSV and MP infection.