郴州地区5岁以下住院儿童严重急性呼吸道感染病毒病原学研究

A Study on Viral Etiological of Hospitalized Children Aged Less than 5 Years with Severe Acute Respiratory Tract Infection in Chenzhou

目的:通过对郴州地区2013-2014年5岁以下住院儿童严重急性呼吸道感染病毒病原学的病例对照研究,了解该地区的病毒流行病学特征,为临床诊治和疾病预防控制提供参考。方法:收集2013年7月-2014年6月因严重急性呼吸道感染住院患儿的鼻咽拭子489份,同时采集年龄、时间相匹配的无感染症状对照244份,采用real-time RT-PCR方法检测呼吸道合胞病毒(RSV)、鼻病毒(HRV)、偏肺病毒(HMPV)、A型流感病毒(IFV-A)、B型流感病毒(IFV-B)、C型流感病毒(IFV-C)、副流感病毒1~4型(PIV1~4)、腺病毒(ADV)、博卡病毒(HBoV)、肠道病毒(EV)及冠状病毒(HCoV-OC43、HCoV-NL63、HCoV-229E、HCoV-HKU1)。结果:489份病例组中有359份(73.41%)至少检测到1种病毒,RSV检出率最高,为27.61%,其次为ADV 9.82%、HRV 9.41%、IFV-A 8.38%、PIV2 7.15%,HMPV 5.32%,HPeV未检出。244份对照中有65份(26.64%)至少检测到1种病毒,PIV2、IFV-B、HKU1、PIV4、HPeV未检出,检出最高的为HRV 10.25%,病例组病毒总检出率比对照组检出率高,且差异有统计学意义。除HRV、冠状病毒、HBoV、IFV-C、PIV4、EV病例组与对照组检出率差异无统计学意义外,其他病毒病例组检出率比对照组明显高。各病毒主要检出年龄与季节都不同,病毒混合感染以RSV合并HRV感染为主。结论:RSV、ADV、IFV-A、IFV-B、HMPV、PIV1~3是郴州地区儿童SARTI的重要病原,以冬春季主要流行,12~35个月儿童易感,而HBoV、IFV-C、PIV4、EV、HRV和冠状病毒可能是重要的无症状潜伏感染病毒。

Objective：We conducted a case-control study on viral etiological of hospitalized children who are younger than 5years with severe acute respiratory tract infection（SARTI）in Chenzhou from 2013 to 2014,to understand the virus epidemiological characteristics of this region,to provide reference for clinical diagnosis,disease prevention and control.Methods：489hospitalized children（case patients）with SARTI and 244 randomly selected,concurrently sampled age-matched-asymptomatic individuals（control subjects）among children aged less than 5years from July 2013 to June2014enrolled in this study.Nasopharyngeal and oropharyngeal swabs of participants were tested for respiratory syncytial virus（RSV）,rhinovirus（HRV）,human metapneumovirus（HMPV）,human influenza virus A（IFV-A）,human influenza virus B（IFV-B）,human influenza virus C（IFV-C）,Parainfluenza 1~4（PIV1~4）,adenovirus（ADV）,human bocavirus（HBoV）,enterovirus（EV）and human coronavirus（HCoV-OC43,HCoV-NL63,HCoV-229 E,HKU1）using real-time fluorescence polymerase chain reaction（RT-PCR）.Results：Among the 489 case patients enrolled,at least one virus was detected in 359（73.41%）,RSV was the most frequently detected virus（27.61%）,followed by ADV（9.82%）,HRV（9.41%）,IFV-A（8.38%）,PIV2（7.15%）,HMPV（5.32%）,and no HPeV was detected.Among the244 control subjects enrolled,at least one viruse was detected in 65（26.64%）and no PIV2,IFV-B,HKU1,PIV4,HPeV were detected,the most commonly detected viruse were HRV（10.25%）.The overall positive rate of viral detection of case patients was higher than control subjects.Besides HRV,HCoV,HBoV,IFV-C,PIV4 and EV,positive rate of other viral detection of case patients was higher than control subjects.The major age and season of different viral detection were differences.RSV and HRV co-infection were the most common during mixed infection.Conclusion：RSV,ADV,IFV-A,IFV-B,HMPV,PIV1~3 were important etiologies of children with SARTI in Chenzhou.The viral pathogens were detected mainly during winter and spring and were more often detected in 12 to 35 months patients.While HBoV,IFV-C,PIV4,EV,HRV and HCoV can be important asymptomatic latent infection viral pathogens.