呼吸道合胞病毒和人类偏肺病毒致儿童急性毛细支气管炎临床分析

Clinical Analysis of Respiratory Syncytial Virus and Human Metapneumovirusin in Children with Acute Bronchiolitis

目的：探讨呼吸道合胞病毒（RSV）和人类偏肺病毒（h MPV）所致婴幼儿急性毛细支气管炎的临床表现、住院时间、肺功能的差异。方法：收集苏州大学附属儿童医院2011-2012年收治住院的急性呼吸道感染患儿,无菌负压吸引法吸取新鲜痰液1~2 m L,采用直接免疫荧光法（DFA）检测常见病毒抗原,逆转录-聚合酶链反应（RT-PCR）扩增h MPV的N基因,以明确诊断。选取其中RSV急性毛细支气管炎155例（RSV组）、h MPV急性毛细支气管炎46例（h MPV组）进行临床分析,对部分RSV（50例）、h MPV（31例）感染患儿进行肺功能检测,并选取同龄健康儿童49例作为正常对照组。结果：确诊为儿童急性毛细支气管炎的住院患儿共计653例,其中RSV感染占23.74%（155/653）,h MPV感染占7.04%（46/653）,二者主要临床表现均为低氧血症、发热、咳嗽、喘息、鼻塞、流涕、气促,但h MPV组低氧血症、发热、喘息、气促的发生率比RSV组低,住院时间比RSV组短（P均〈0.05）。RSV和h MPV急性毛细支气管炎患儿肺功能均有不同程度受损,主要表现为小气道功能障碍,但两组肺功能各项指标比较差异均无统计学意义（P均〉0.05）。结论：h MPV和RSV都是儿童急性毛细支气管炎常见病原之一。RSV、h MPV急性毛细支气管炎患儿临床表现、肺功能相似,但后者症状较轻、住院时间较短。潮气呼吸肺功能检测有利于评估RSV、h MPV感染后肺功能损害程度,可为临床诊治提供客观依据。

Objective： To discuss the clinical manifestation,hospital stays and pulmonary function of infants with respiratory syncytial virus（ RSV） and human metapneumovirus（ h MPV） bronchiolitis. Methods： The children admitted with acute respiratory tract infection from 2011 to 2012 were enrolled in Children＇s Hospital Affiliated to Suzhou University,and 1 ~ 2 m L fresh sputum were adopted using vacuum aspiration from all children. Virus antigen was detected by direct immunofluorescence assay. At the mean time,N gene sequence of h MPV was amplified by reverse transcriptase polymerase chain reaction. Clinical analysis were proceeded with 155 cases with RSV acute bronchiolitis（ RSV group） and 46 cases with h MPV acute bronchiolitis（ h MPV group）,49 case of healthy children with the same ages.Results： The incidence of RSV infection was 23. 74 percent in-patient comparing with 7. 04 percent of h MPV infection. Frequency of hypoxemia,fever,wheezing and tachypnea in children with h MPV bronchiolitis were lower,the hospital stays were shorter than those of children with RSV infection. All children＇s pulmonary function with RSV or h MPV bronchiolitis were damaged to some extent,and the small airway function damage was the main performance,but there were no significant difference in children with h MPV group and the RSV group in indexs of pulmonary function（ P〈0. 05）. Conclusion： h MPV and RSV were common pathogens in children respiratory tract infection. Both of the pathogens have the similar clinical manifestation and the pulmonary function. The tidal breathing analysis is useful for evaluating the damage of pulmonary function and could provide objective evidence for clinic diagnosis and treatment.