社区获得性肺炎患儿中人冠状病毒感染的多中心研究

A multicenter study of human coronavirus infections in children with community-acquired pneumonia

目的了解社区获得性肺炎(community-acquired pneumonia,CAP)患儿中人冠状病毒(human coronavirus,HCoVs)的感染状况。方法 2014年11月至2016年11月,从6个地区的13家医院采集诊断为CAP的患儿的鼻咽抽吸物(nasopharyngeal aspirations,NPAs)或咽拭子,应用液相芯片技术筛查标本中4种人冠状病毒OC43、HKU1、229E和NL63,分析其流行特征和重症肺炎及并发症。结果共采集3 047例CAP患儿的NPAs或咽拭子:(1)病毒总检出率为52.94%(1 613/3 047),HCoVs检出率为2.53%(77/3 047),其中HCoV-OC43的检出率最高,为1.38%(42/3 047);(2)2015年北方地区春季HCoVs检出率为4.92%(16/325),夏季为4.27%(14/328),秋季为1.40%(5/357),冬季为1.42%(3/211)。南方地区春季检出率为3.56%(19/534),夏季为0.57%(2/353),秋季为2.50%(5/200),冬季为1.56%(2/128);(3)0~1岁、1~3岁、3~6岁和≥6岁年龄组的HCoVs检出率分别为3.48%(30/861),2.53%(24/950),2.58%(18/697)和0.93%(5/539),4个年龄组间检出率总体差异有统计学意义(χ2=8.809,P=0.032);(4)各地区HCoVs检出率最高的年龄组为:华北0~1岁组(3.89%,7/180),西北0~1岁组(12.50%,3/24),东北0~1岁组(3.17%,2/63),华东1~3岁组(2.74%,9/328),西南0~1岁组(4.65%,12/258)和华南0~1岁组(2%,1/50);(5)8例HCoVs阳性的重症肺炎患儿中,6例为HCoVs单纯感染,其中3例伴有胸腔积液,2例并发急性呼吸衰竭。结论 HCoVs是儿童CAP的重要病毒病原之一;婴幼儿为HCoVs感染的高发人群;HCoVs感染可致重症肺炎,发生严重并发症。

Objective To study human coronaviruses（HCoVs）infections in children with community-acquired pneumonia（CAP）. Methods From November 2014 to November 2016,the nasopharyngeal aspirations（NPAs）or throat swabs from children diagnosed with CAP were collected from 13 pediatric hospitals in six regions of China.Respiratory specimens were screened for 18 respiratory viruses,including HCoVs（OC43,229 E,NL63and HKU1）by Luminex liquid chip technology.In addition,the epidemiological characteristics and severe pneumonia of children infected with HCoVs were analyzed. Results A total of 3 047 NPAs or throat swab samples were collected.（1）The total positive rate of the virus detected was 52.94%（1 613/3 047）,HCoVs were detected in 77（2.53%）patients,and OC43 was the most prevalent with the positive rate of 1.38%（42/3 047）.（2）In 2015,the detection rate of HCoVs was 4.92%（16/325）in spring,4.27%（14/328）in summer,1.40%（5/357）in autumn and 1.42%（3/211）in winter in the northern districts of China.While in the southern districts of China,the detection rate of HCoVs was 3.56%（19/534）in spring,0.57%（2/353）in summer,2.50%（5/200）in autumn and 1.56%（2/128）in winter.（3）Positive rate of HCoVs infections in0-1year group,1-3years group,3-6years group and ≥6years group were 3.48%（30/861）,2.52%（24/950）,2.58%（18/697）and 0.93%（5/539）,respectively.There were significant differences in positive rate of HCoVs among four groups（χ2=8.809,P=0.032）.（4）The highest positive rate of HCoVs in four age groups in six regions was 0-1year group in North China（3.89%,7/180）,0-1year group in northeast region（12.50%,3/24）,0-1years old group in northeast region（3.17%,2/63）,1-3year group in East China region（2.74%,9/328）,0-1year in southwest（4.65%,12/258）and 0-1year in South China region（2%,1/50）,respectively.（5）There were 8severe pneumonia cases among HCoVs positive patients.Six patients were single infection of HCoVs,including 3cases associated with pleural effusion and 2cases with acute respiratory failure. Conclusions HCoVs was an important viral pathogen in children with CAP.HCoVs infections are common in children under 3years old.HCoVs infections can cause severe pneumonia and severe complications.