小儿急性鼻窦炎呼吸道病原体筛查与临床特征分析

Respiratory Pathogens Screening and Clinical Characteristics Analysis for Pediatric Acute Rhinosinusitis Patients

目的急性上呼吸道感染（URI）是儿科门诊最常见的疾病之一,其病毒学病因发挥着重要的作用。由于病毒对鼻腔、鼻窦上皮细胞及纤毛的损害,URI的感染多数会进一步导致小儿的鼻窦炎感染。因此,通过病原体筛选和临床特征分析,来比较急性鼻窦炎（ARS）组与对照组的病毒发生率。方法对该组564例儿科患者进行鼻粘膜拭子采样,其中259例为ARS患儿（Ⅰ组）,219例为急性URI患儿（Ⅱ组）,86名为对照组（Ⅲ组）。应用多重PCR技术对每组的呼吸道病毒及病原体进行比较。结果感染了呼吸道病毒的患儿进一步发展为鼻窦炎（RS）的风险将增加3.104倍（RR=3.104,95%CI=2.134-4.517）。Ⅰ组中的鼻病毒（RV）与腺病毒（ADV）含量均高于Ⅱ组（P〈0.05）,其余的病原体在两组间的差异无统计学意义（P〉0.05）。Ⅰa组（单纯ARS组）中RV的感染率明显高于其他组（P〈0.01）;与其他组比较,ADV的感染率在Ⅰb组（急性URI伴ARS）患儿中更常见（P〈0.05）。鼻腔分泌物的涂片分析结果显示,49.6%的Ⅰ组样品中可见免疫细胞的渗出,此结果几乎与该组的病原体检出率（47.4%）相等。结论小儿急性URI发展为ARS的的患者中,病毒RV与ADV担当了比较重要的作用,特别是RV,这部分患儿的鼻腔分泌物中可见中性粒细胞和淋巴细胞的渗出。应该通过不同的采样医院,在连续季节收集更多的ARS样本量,以便更好地推广该研究。

Objective Acute upper respiratory tract infection（AURI） is a common disease in most pediatric outpatients, and viral etiolo-gies have been shown to play an important role.However, the URI infection following to result most pediatric sinus infections, which is known to damage the nasal/ sinus epithelial cells and cilis. Therefore, the pathogens screening and clinical characteristics analysis were conducted to determine the prevalence of viruses in acute rhinosinusitis（ARS） and controls groups. Methods Nasal swab（NS）samples were collected from 564 pediatric outpatients, which were 259 ARS patients（group Ⅰ）, 219 AURIs patients（group Ⅱ） and 86controls（group ⅡI） respectively. Multiplex PCR was used to identify respiratory viruses in each group and the pathogens were com-pared with each other. Results The datas were shown that infected with respiratory viruses would increase 3.104-fold risk become RS（RR=3.104, 95%CI=2.134-4.517）. Only RV and ADV had a higher rate in group Ⅰ than group Ⅱ（P〈0.05）, the rest pathogens shown no significant difference either（P〉0.05）. RV infection rate in group Ia（ARS only） was absolutely higher than other groups（P〈0.01）,ADV was more prevalent in the AURI population with ARS（group Ib）（P〈0.05）. Effusion of immune cells have been found in 49.6%group I samples by cell smearing analysis, which nearly equal to the pathogen detection rate of group I（47.4%）. Conclusion This in-vestigation proved that RV and ADV contribute more on ARS development, especially RV, which made children have more chance developing to ARS with the neutrophils and lymphocyte effusion in nasal mucosa. Further studies should be done to generalize the re-search by incresing sample capacity and collecting ARS patients from different hospital during continuous seasons.