儿童急性呼吸道感染病原学特征分析

Analysis of pathogen characteristics in children with acute respiratory tract infection

目的了解门诊和住院儿童急性呼吸道感染病例中呼吸道病毒和肺炎支原体、衣原体的流行特征，为防控急性呼吸道感染、指导临床用药奠定基础。方法采集2011—2013年杭州某儿童医院呼吸道门诊病例咽拭子、住院病例气管吸取物。采用实时荧光PCR方法，对收集到的样本进行呼吸道病毒和肺炎支原体、衣原体的核酸检测。结果本研究908例病例中，610例检出至少1种病原体，总的病原体检出率为67.2%（610/908），住院患儿检出率（76.7%）显著高于门诊患儿（43.0%）（χ^2＝94.79，P〈0.001）。206例检出2种或2种以上病原体，住院患儿合并感染率（29.0%）高于门诊患儿（6.6%）（χ2＝52.34，P〈0.001）。呼吸道合胞病毒、副流感病毒、鼻病毒、流感病毒、博卡病毒、腺病毒、saffold心肌炎病毒及肺炎支原体、衣原体在两组病例间检出率的差异均有统计学意义。住院病例中，检出率最高的是呼吸道合胞病毒（34.5%），其次是肺炎支原体（15.0%）、鼻病毒（14.6%）；门诊病例中，检出率最高的是腺病毒（15.2%），其次是流感病毒（11.7%）、副流感病毒（7.8%）。住院病例中除了呼吸道合胞病毒和流感病毒外，其他病原合并感染率均大于其单一感染率。腺病毒在门诊和住院病例中的合并感染率差异具有统计学意义（χ^2＝18.90，P〈0.001）。未发现住院病例单一感染与合并感染临床特征的显著性差异。结论住院病例呼吸道病原体的检出率较门诊病例高，多种病原体合并感染在住院病例中较常见，提示合并感染和疾病的严重程度有一定相关性。

Objective To determine the epidemic characteristics of respiratory viruses, myeoplasma pneumonia（MP） and chlamydia pneumoniae（CP） in outpatients and hospitalized children with acute respiratory tract infections（ARI） , to lay a foundation for the prevention and control of ARI. Methods From 2011 to 2013, children with ARI, including outpatients and inpatients, were involved in this study. One nasopharyngeal aspirate or throat swab specimen was collected from each patient. Real time PCRs were performed to detect common respiratory tract viruses, MP and CP. Results At least one pathogen was identified in each of 610 out of 908 patients and the overall positive rate was 67.2%. The positive rate in inpatient（76.7% ）was higher than that in outpatient（43.0% ） （X2 = 94.79, P 〈 0. 001 ）. Simultaneous detection of two or more viruses was found in 206 cases. Co-infection was more frequent in inpatients than in outpatients（29.0% VS 6.6% , P 〈 0. 001 ）. Significant differences of the detection rate were observed in RSV, PIV, HRV, Flu, human bocavirus （hBoV） , adenovirus （AdV） , saffold virus（SAFV） , MP and CP between the inpatient and outpatient group. Respiratory syneytial virus （RSV） （34.5%） was the most prevalent virus detected among hospitalized children, followed by MP（ 15.0% ）and human rhinovirus（ HRV ） （ 14.6% ）. Whereas adenovirus（AdV） （ 15.2% ） was the most frequently identified virus in the outpatient group, followed by influenza virus （Flu） （ 11.7% ） ） and PIV （7.8%）. Except for RSV and Flu, co-infection of the other pathogens was more frequent than its mono-infection in inpatients. Significant differences of the AdV co-infection rate were observed between the inpatient and outpatient group （X2 = 18.90, P 〈 0. 001 ）.Compared with mono-infection, co-infection has no significant effect on the clinical presentation. Conclusions The detection rate of respiratory pathogens was higher in inpatients than in outpatients with ARI, and co-infections were more popular in children hospitalized, it may show that co-infection had some correlation with disease severity.