甲型流感儿童病毒核酸持续时间及其影响因素

Influencing factors for duration of viral nucleic acid shedding in children with influenza A

目的分析甲型流感(甲流)患儿病毒核酸持续时间的规律和影响因素。方法收集90例鼻咽拭子甲流病毒核酸PCR检测阳性的甲流患儿临床资料,并将其分为单纯甲流组(10例)、甲流并发肺炎组(61例)、甲流并发神经系统损害组(10例)、基础疾病合并甲流组(9例),对其临床特点、治疗经过、病毒核酸持续时间和转归进行回顾性分析。结果 90例甲流患儿的前5位临床症状主要为发热(89/90,99%)、咳嗽(89/90,99%)、流涕(69/90,77%)、气促(26/90,29%)、肌痛(23/90,26%)。病毒核酸持续时间平均9.4±2.9 d。单纯甲流组病毒核酸持续时间短于甲流并发肺炎组、甲流并发神经系统损害组及基础疾病合并甲流组,差异均有统计学意义(P<0.05);甲流并发肺炎组、甲流并发神经系统损害组及基础疾病合并甲流组之间的病毒核酸持续时间的差异均无统计学意义(P>0.05)。起病48 h内抗病毒治疗组的病毒核酸持续时间和体温恢复正常所需时间均短于48 h以后用药的患儿,差异有统计学意义(P<0.05)。83%的体温恢复正常的甲流患儿病毒核酸仍呈阳性。结论并发症、基础性疾病和抗病毒治疗时机是影响甲流病毒核酸持续的主要因素,体温是否恢复正常不宜作为甲流患儿是否继续抗病毒治疗的参考。

Objective To investigate the features and duration of viral nucleic acid shedding in children with influenza A.Methods The clinical data of 90 children with influenza A with positive influenza A virus nucleic acid in nasopharyngeal swab detected by PCR were collected,and these children were divided into simple influenza A group（n=10）,influenza A-pneumonia group（n=61）,influenza A-nervous system damage group（n=10）,and influenza A-underlying disease group（n=9）.A retrospective analysis was performed for clinical features,treatment process,duration of viral nucleic acid shedding,and prognosis.Results The most common symptoms in these children were fever（89/90,99%）,cough（89/90,99%）,running nose（69/90,77%）,shortness of breath（26/90,29%）,and myalgia（23/90,26%）.The mean duration of viral nucleic acid shedding in 90 children was 9.4±2.9 days.The simple influenza A group had a significantly shorter duration of viral nucleic acid shedding than the influenza A-pneumonia,influenza A-nervous system damage,and influenza A-underlying disease groups（P〈0.05）,while there were no significant differences between the influenza A-pneumonia,influenza A-nervous system damage,and influenza A-underlying disease groups（P〈0.05）.The children who received antiviral therapy within 48 hours after disease onset had significantly shorter duration of viral nucleic acid shedding and time to body temperature recovery than those who received antiviral therapy more than 48 hours after disease onset（P〈0.05）.Of all the children with body temperature recovery,83% still tested positive for viral nucleic acid.Conclusions Complications,underlying diseases,and timing of antiviral therapy are influencing factors for the duration of influenza A virus nucleic acid shedding,and whether body temperature returns to normal cannot be used to decide whether to continue antiviral therapy.