儿童呼吸道人副流感病毒感染临床特征及流行病学特点

Epidemiological and clinical characteristics of respiratory human parainfluenza virus infection in children

目的了解苏州地区儿童呼吸道人副流感病毒（HPIV）感染的临床特点及流行病学特征，为儿童呼吸道感染预警及诊治提供循证医学依据。方法收集2006年1月至2015年12月连续10年因急性呼吸道感染在苏州大学附属儿童医院住院治疗患儿的病史及鼻咽分泌物。采用直接免疫荧光法检测呼吸道合胞病毒，流感病毒A、B型，HPIVⅠ，HPIVⅡ，HPIVⅢ及腺病毒7种常见呼吸道病毒，荧光定量PCR法检测肺炎支原体（MP）、肺炎衣原体及博卡病毒（hBoV），反转录－PCR法检测鼻病毒及偏肺病毒等，并进行细菌培养。结果21 769例标本中共检出HPIV感染829例（3.81%），其中HPIVⅠ、HPIVⅡ、HPIVⅢ分别检出113例（0.52%）、16例（0.07%）及700例（3.21%）。829例HPIV阳性病例中，387例单纯感染，428例混合感染，以混合感染肺炎链球菌、流感嗜血杆菌、MP、hBoV为主；男童检出率[4.14%（563/13 591例）]高于女童检出率[3.25%（266/8 178例）]，差异有统计学意义（χ^2＝11.036，P＝0.001）。在28 d～1岁组和〉1～3岁组检出率较高，分别为4.71%（494/10 476例）、4.21%（244/5 793例）。主要在春、夏季流行。单纯HPIVⅠ及HPIVⅢ感染后临床主要表现为咳嗽、发热、喘息，HPIVⅠ较HPIVⅢ感染后更易出现发热[71.74%（33/46例）比40.12%（134/334例）]、气促[10.87%（5/46例）比2.10%（7/334例）]，差异均有统计学意义（χ^2＝16.410，P〈0.001；χ^2＝10.177，P＝0.001）；感染导致的呼吸道疾病主要为肺炎。结论苏州地区住院儿童HPIV感染以HPIVⅢ亚型为主，在春、夏季节流行，3岁以下儿童是最易感染的年龄段，检出率随年龄增加逐渐下降。

Objective To study the epidemiological and clinical features of human parainfluenza virus （HPIV） infection in children in Suzhou, and to provide the evidence - based foundation for early warning, diagnosis and treatment of respiratory infection in children. Methods The sputum specimens and medical history were obtained from children with acute respiratory tract infection hospitalized at the Childen＇s Hospital Affiliated to Soochow University from January 2006 to December 2015. Seven kinds of common respiratory viruses including respiratory syncytial virus, influenza virus A,influenza virus B,HPIV Ⅰ ,HPIV Ⅱ ,HPIV Ⅲ and adenovirus were detected by using the direct immunofluorescence. Mycoplasma pneumoniae（MP） , chlamydia pneumoniae, human bocavirus （ hBoV ） were detected by using fluorescence quantitative PCR. Rhinovirus and human metapneumovirus were detected by using reverse transcription- PCR. Sputum was cultured for bacteria. Results In 21 769 cases, the detection rate of HPIV positive was 3.21% （ 829 cases） , among which, HPIV Ⅰ , HPIV Ⅱ , HPIV Ⅲ were respectively detected in 113 cases （0.52%） , 16 cases （0.07%） and 700 cases （3.21%）, respectively. There were 378 cases of simple infection and 428 cases of mixed infection,and the mixed infection was very common in Streptococcus pneumoniae, Haemophilus influenza, MP and hBoV. There was a difference in HPIV infection among genders, and the detection rate of the boys was higher than that of girls[4.14% （563/13 591 cases） vs. 3.25% （266/8 178 cases） ,χ^2 = 11. 036,P =0. 001 ]. In the 28 d - 1 year old and 〉 1 -3 year old group, the detection rate of HPIV was higher [ 4.71% （494/10 476 cases） and 4.21% （244/5 793 cases ） , respectively ]. In spring and summer, there was a higher detection rate of HPIV infection. The clinical manifestations with simple infection of HPIV [ and HPIV m were cough, fever and wheezing. The rate of fever and shortness of breath in those of HPIV I was 71.74% （ 33/46 cases） , 10.87% （5/46 cases） , and that in HPIV Ⅲ was 40. 12% （ 134/334 cases） ,2.10% （7/334 cases） , HPIV Ⅰ infection was more likely to cause fever and shortness of breath than those of HPIV Ⅲ ,there were significant differences （χ^2 = 16. 410 ,P 〈 0.001 ;χ^2 = 10. 177 ,P = 0. 001 ）. Pneumonia had the highest detection rate of viral infection. Conclusions HPIV m is the leading pathogen among the types of HPIV in the hospitalized children in Suzhou area. Among the subtypes of HPIV, the peak of HPIV infection occurs in spring and summer. The children less than 3 years old are the most susceptible to parainfluenza virus, and the HPIV detection rate is gradually declines with age.