白银市5岁以下急性下呼吸道感染住院儿童病原学分析

Etiology of acute lower respiratory tract infections among hospitalized children in Baiyin city,Gansu province of China

目的了解白银市5岁以下急性下呼吸道感染(acute lower respiratory tract infection,ALRTI)住院儿童的病原。方法 2012年7月~2013年7月在甘肃省白银市3家医院采集391例5岁以下急性下呼吸道感染住院儿童鼻咽分泌物,采用一步法多重实时荧光PCR检测多种常见呼吸道病原体。结果 391份标本病原学检出率为91.56%(358/391),病毒和细菌检出率分别为81.07%和61.38%,单种病原学阳性率为30.18%(118/391),混合感染率为61.38%(240/391)。肺炎链球菌、呼吸道合胞病毒和流感嗜血杆菌检出率最高,分别为42.71%、30.69%、20.46%;人鼻病毒、副流感病毒(1~4型)、人偏肺病毒、肺炎支原体的检出率较高,分别为19.69%、18.16%、13.04%、12.53%;腺病毒、甲型流感病毒、4种冠状病毒、人博卡病毒和金黄色葡萄球菌相对少见,检出率分别为8.18%、6.65%、6.39%、6.14%和3.32%,未检出乙型流感和衣原体,流感、呼吸道合胞病毒、支原体有典型的冬春季流行高峰。结论甘肃省白银市5岁以下急性下呼吸道感染住院儿童中同时检出2种以上病原的比例高,肺炎链球菌、呼吸道合胞病毒、流感嗜血杆菌、人鼻病毒、副流感病毒、人偏肺病毒和肺炎支原体是主要常见感染原,病毒性感染占优势,混合感染多见。

Objective To investigate the pathogens of acute lower respiratory tract infections（ALRTI）among hospitalized children in Baiyin city,Gansu province of China. Methods A total of 391 children with clinical diagnosis of ALRTI during the period of July 2012 to July 2013 were recruited in our study.One nasopharyngeal aspirate specimen was collected from each patient.Real-time PCR was performed to detect common respiratory pathogens. Results At least one pathogen was detected in 358 out of 391 patients and the overall positive rate was 91.56%.Of which,317（81.07%）were positive for at least one virus,240（61.38%）were positive for at least one bacterium.Streptococcuspneumoniae（SP）was the most frequently detected pathogen（167/391,42.71%）,respiratory syncytial virus（RSV）was the most frequently detected virus（120/391,30.69%）,followed by Haemophilus influenzae（HI）（20.46%）,human rhvirus（RV）（19.69%）,parainfluenza virus（PIV 1-4）（18.16%）,human metapneumovirus（hMPV）（13.04%）,Mycoplasma pneumonia（MP）（12.53%）,human adenovirus（Adv）（8.18%）,influenza A（IFV A）（6.65%）,human coronavirus（CoV）（6.39%）,human bocavirus（BoV）（6.14%）.RSV was the most common pathogen in patients under 1 year and showed seasonal variation with peaks during winter and spring. Conclusions Two or more pathogen coinfections were detected in ALRTIs cases of hospitalized patients under the age of 5 in Baiyin city of Gansu province in China.Streptococcus pneumoniae,RSV,HI,RV,PIVs,hMPV and MP are the main infections.