混合感染因素对呼吸道偏肺病毒感染临床特征的影响

Influence of coinfection factors on clinical features of human metapneumovirus infection

目的探讨混合其他病原感染对人偏肺病毒（hMPV）感染患儿的影响。方法选取2010年6月至2015年5月入住苏州大学附属儿童医院呼吸科的11 299例急性呼吸道感染患儿，入院时采集鼻咽分泌物行痰多病原学检查，采集外周血行血常规、C反应蛋白（CRP）、肝功能及细胞免疫检测。结果11 299例患儿中共检出hMPV阳性222例（1.96%），其中hMPV单纯感染者114例（51.4%），混合其他病原感染者108例（48.6%），以hMPV混合细菌感染最为常见（63例，占28.4%）。多重混合感染患儿的平均年龄显著高于单纯hMPV感染者[（2.43±2.47）岁比（1.27±1.30）岁]，差异有统计学意义（P〈0.05）。hMPV混合细菌感染及多重混合感染患儿出现发热的比例（63.5%及70.0%）明显高于hMPV单纯感染患儿（43.0%），差异均有统计学意义（χ^2＝6.827、4.986，均P〈0.05）。其他临床症状在各组之间差异均无统计学意义（均P〉0.05）。多重混合感染患儿外周血中性粒细胞比例（0.50±0.18）显著高于hMPV单纯感染患儿（0.37±0.19）、hMPV混合细菌（0.39±0.19）及hMPV混合其他病毒感染患儿（0.35±0.19），差异均有统计学意义（均P〈0.05）。hMPV混合细菌感染患儿中30.2%（19/63例）CRP升高，显著高于hMPV单纯感染患儿（16.7%，19/114例），差异有统计学意义（χ^2＝4.381，P〈0.05）。多重混合感染患儿CD3^＋CD4^＋最低（0.31±0.07），但与其他各组比较差异无统计学意义（均P〉0.05），而hMPV混合其他病毒感染患儿CD19^＋CD23^＋显著高于hMPV单纯感染、hMPV混合细菌感染、hMPV混合支原体感染及多重混合感染患儿（0.37±0.10比0.30±0.09、0.30±0.08、0.29±0.07、0.29±0.09），差异均有统计学意义（均P〈0.05）。结论hMPV感染易并发混合感染，以混合细菌感染最为常见，当患儿中性粒细胞比例和CRP升高时需警惕混合细菌感染。混合感染并不明显加重hMPV感染临床症状，但在一定程度上可加剧患儿细胞免疫紊乱。

Objective To explore the influence of coinfection with other pathogens on human metapneumovi-rus （hMPV） infection in children.Methods A total of 11 299 children admitted to the Department of Respiratory Disease, Children′s Hospital of Soochow University between June 2010 and May 2015 were enrolled in this study.Sputum specimens were collected and multiple pathogenic joint detection was done, including peripheral blood, and blood routine, C reactive protein （CRP）, hepatic function and cellular immunity.Patients′ clinical data were collected.Results Among 11 299 hospitalized children, hMPV was positive found in 222 children （1.96%）. One hundred and fourteen children （51.4%） had hMPV simple infection and 108 cases of them （48.6%） were coinfected with other pathogens.The hMPV coinfected with bacteria （63 cases, 28.4%）was most common.The average age of multiple coinfected children was older than that of simple hMPV infection in children[（2.43±2.47）years old vs.（1.27±1.30） years old], and the difference was significant （Z=-2.360, P〈0.05）. Fever seemed to be more common in children coinfected with bacteria or multiple coinfection （63.5% and 70.0%） compared with those with simple hMPV infection （43.0%）, and the differences were significant （χ^2=6.827, 4.986, all P〈0.05）. There was no significant difference in other clinical features among 5 groups （all P〉0.05）. Multiple coinfection children had a higher percentage of neutrophils （0.50±0.18） than that in simple hMPV infection children （0.37±0.19）, children coinfected with bacteria （0.39±0.19） or other virus （0.35±0.19）, and the differences were significant （all P〈0.05）. CRP was elevated in 30.2% （19/63 cases） of children coinfected with bacteria, which was significantly higher than that of simple hPMV infection children （16.7%, 19/114 cases）, and the difference was significant （χ^2=4.381, P〈0.05）. CD3^＋ CD4^＋ was significantly lower in multiple coinfection children （0.31±0.07）, but there were no significant difference compared with other groups （all P〉0.05）. CD19^＋ CD23^＋ was significantly higher in children coinfected with other virus compared with that of simple hMPV infection group, hMPV coinfected with bacteria, hMPV coinfected with Mycoplasma pneumonia and multiple coinfect group（0.37±0.10 vs. 0.30±0.09, 0.30±0.08, 0.29±0.07, 0.29±0.09）, and the differences were significant （all P〈0.05）.Conclusions It is suggested that hMPV seems easily coinfected with other pathogens, especially with bacteria.It should be on high alert that bacteria coinfection is accompanied with high percentage of neutrophils and high level of CRP.Coinfection does not significantly exacerbate the clinical symptoms of hMPV infection, but may exacerbate the cellular immune disorders to a certain extent.