儿童急性下呼吸道人博卡病毒感染及临床特征的比较研究

Clinical analysis of acute lower respiratory tract infections with human bocavirus among children in Beijing of China

目的探讨人博卡病毒(HBoV)在儿童急性下呼吸道感染(ALRTI)中的作用及临床特征。方法2007年3月至2015年2月北京儿童医院内科急救室就诊及内科住院的ALRTI患儿共4 370例,采用多重RT-PCR方法,对患者鼻咽吸取物进行常见呼吸道病毒检测,包括呼吸道合胞病毒(RSV)、人鼻病毒(HRV)、副流感病毒(PIV)1~4型、甲型流感病毒(IFA)、乙型流感病毒(IFB)、丙型流感病毒(IFC)、腺病毒(adenovirus,ADV)、肠道病毒(EV)、人冠状病毒(HCoV)、人偏肺病毒(HMPV)及人博卡病毒(HBoV)。对HBoV的检出率、感染季节及阳性病例的临床特征进行分析,比较分析单纯HBoV感染儿童ALRTI病例的临床特征。结果(1)HBoV的总阳性检出率为7.05%(308/4 370)。在HBoV阳性病例中,存在一种及以上病毒混合感染的病例占78.90%(243/308),其中名列前3位的混合感染病毒为RSV、HRV和PIV。(2)急性下呼吸道HBoV感染住院患者共179例,其中,90.50%(162/179)临床诊断为支气管肺炎,其次为支气管炎、毛细支气管炎。主要临床表现包括咳嗽、发热、喘息、呼吸困难、腹泻,常见并发症包括心肌损害、肝功损害、呼吸衰竭和心力衰竭。(3)符合入选标准的单纯HBoV感染的肺炎患儿和单纯RSV感染的肺炎患儿、HBoV与RSV混合感染的肺炎患儿比较,单纯HBoV感染组的平均年龄显著大于后两者(P<0.001);发热比例高于后两者(P=0.003);HBoV与RSV的混合感染的肺炎患儿,呼吸困难的发生率显著高于两种病毒单纯感染的肺炎患儿(P=0.004)。3组在其余临床症状、机械通气、并发症等方面比较差异无统计学意义。结论小于3岁儿童是儿童HBoV感染ALRTI的主要人群。HBoV感染全年散发,且存在较高的混合感染率。单纯HBoV可致儿童呼吸道感染,且HBoV与RSV的混合感染可能更容易引起呼吸困难,加重疾病的严重程度。

Objective To study the clinical characteristics of acute lower respiratory tract infection （ALRTI）. Methods A total of 4 370 children with clinical diagnosis of ALRTI during the period of March 2007 to February 2015 were enrolled into this study. These cases were hospitalized patients or outpatients in Emergency Department in Beijing Children＇ s Hospital. Each patient＇ s nasopharyngeal aspirate specimen was collected at the time of admission. Reverse transcription （RT） PCR was used to detect common respiratory viruses inclu- ding respiratory syncytial virus （RSV）, human rhinovirus （HRV）, parainfluenza virus （PIV） type 1-4, ade novirus （ADV）, human coronavirus （HCoV）, enterovirus （EV）, human metapneumovirus （HMPV） and human bocavirus （HBoV）. The incidence, epidemiological and clinical features of ALRIT with HBoV infections were analyzed. According to inclusion criteria, a comparison study of clinical features was carried out among three groups of pneumonia with single HBoV infection, single RSV infection and coinfecion with RSV and HBoV. Results The positive rate of HBoV was 7.05~ （308/4 370）, and the coinfection rate with one or more mixed virus was 78.90% （243/308）. The top three viruses coinfected with HBoV were RSV, HRV, PIV in order. There were 179 inpatients with ALRTI infected by HBoV, 90.50% （162/179） cases were diag- nosed as bronchial pneumonia, and the others were diagnosed as bronchitis and bronchilitis. The common clinical manifestations include paroxysmal cough, fever, wheezing, dyspnea and diarrhea. There were 7 cases of pneumonia with single HBoV infection, 29 cases of pneumonia with single RSV infection, 21 cases of pneumonia with HBoV and RSV coinfecions. Compared with cases of single RSV infection, coinfections of HBoV and RSV, pneumonia cases of single HBoV infection showed higher incidence of fever and the average age was ol- der. The incidence of dyspnea in the group of HBoV and RSV coinfections was higher than that with single HBoV or single RSV infection. There were no significant differences in others clinical manifestations, compli- cations and mechanical ventilation among these three groups. Conclusions Children under 3 years old were the major population in children with ALRTI caused by HBoV infections. HBoV infection was sporadic throughout a year with high coinfection rate. HBoV infection could result in pneumonia in children. The incidence of dyspnea in the group of HBoV and RSV coinfection was higher than that of single HBoV or single RSV infection.