人冠状病毒在急性下呼吸道感染儿童中的临床特征

Clinical characteristics of human coronavirus in children with acute lower respiratory tract infection

目的了解急性下呼吸道感染住院患儿人冠状病毒（HCoV）感染的临床表现。方法回顾性分析2007年3月至2013年2月在北京儿童医院因下呼吸道感染住院的患儿3503例，患儿在住院当日或次日采集鼻咽吸取物1份，采用反转录（RT）-PCR方法进行常见呼吸道病毒核酸检测，包括呼吸道合胞病毒（RSV）、鼻病毒（RV）、副流感病毒（PIV）1-4型、甲型及乙型流感病毒（IFA、IFB）、腺病毒（AdV）、肠道病毒（EV）、HCoV、偏肺病毒（hMPV）及博卡病毒（HBoV）。同时检测患儿血清支原体抗体及痰细菌培养，将单一HCoV感染患儿的临床资料进行分析。结果3503例患儿中单-HCoV感染11例，男：女为2．7：1．0，中位年龄3个月，HCoV阳性的下呼吸道感染患儿的临床症状主要表现为咳嗽（11／11例，100．0％）、喘息（10／11例，90．9％）、纳差（7／11例，63．6％）、发热（6／11例，54．5％），查体阳性体征主要为双肺呼气相喘鸣音（8／11例，72．7％）及吸气相湿啰音（5／11例，45．4％）。大多数患儿胸片表现为支气管肺炎。血常规白细胞计数多在正常范围。结论HCoV所致的呼吸道感染中，婴幼儿（特别是≤1岁的婴儿）易发展为急性下呼吸道感染。患儿临床表现以咳嗽、喘息、发热为主，还可合并消化道症状如纳差、腹泻等表现。

Objective To describe the clinical characteristics of acute lower respiratory tract infection （ALRTI） caused by human coronavirus （HCoV） in children. Methods Three thousand five hundred and three hospitalized children diagnosed with ALRTI in Beijing Children＇s Hospital from March 2007 to February 2013 were reviewed. Nasopharyngeal aspirate （NPA） specimen was collected from each patient. Reverse transcription （RT） - polymerase chain reaction（PCR） methods were applied to detect common respiratory viruses including respiratory syneytial virus （ RSV）, rhinovirus （ RV ）, parainfluenza virus （ PIV ） type 1 - 4, influenza virus type A and B （ IFA, IFB ）, adenovirus （ AdV）, enterovirus （ EV）, HCoV, human metapneumovirus （bMPV） and human bocavirus （ HBoV ）. Serum antibodies of mycoplasma and sputum bacterial culture were also detected. Only HCoV positive patients were analyzed in this study. Results Eleven of 3 503 patients were proved as HCoV - positive in NPA specimens. Of the 11 children,8 cases were male and 3 cases were female （2.7 ： 1.0）. The median age was 3 months. The clinical symptoms of HCoV infection included cough （ 11/11 cases, 100.0% ）, wheezing （ 10/11 cases ,90.9% ） ,fever （6/11 cases ,54.5% ） and poor appetite （7/11 cases,63.6% ）. Wheezing （8/11 cases,72.7% ） and moist rale in inspiratory phase （5/11 cases,45.4% ） could be heard. Most patient＇s chest X - ray showed bronchopneumonia. Full blood count displayed that leukocyte was in the normal range. Conclusions Respiratory tract infection with HCoV - positive will be easier to spread to ALRTI, especially in infants less than 1 year old. The symptoms include fever, cough and wheezing, but poor appetite and diarrhea can also be detected.