儿童下呼吸道感染病毒病原学及血常规指标

Viral etiology and blood routine indicators of lower respiratory tract infection in children

目的确定导致下呼吸道感染(LRTI)住院儿童的病毒病因及季节性特征。方法在2017年1月至12月期间收集了558名LRTI患者的临床和人口统计信息以及咽拭子标本。采用多重RT-PCR检测鼻咽吸引液标本中16种呼吸道病毒病原体的频率和类型。结果在558例患者中,210例(37.63%)患者至少检出1种病毒呈阳性。其中,单一感染占30.47%(170/558),混合感染占4.30%(24/558),多重感染占2.87%(16/558)。从210例患者中共鉴定272种呼吸道病毒病原体。检出率最高的是RSV(26.47%,72/272),其次是PIV(22.06%,60/272),HRV(21.32%,58/272),CoV(10.29%,28/272)和HAdV(9.56%,26/272)。FluA、hMPV和BoCA分别为4.41%、3.72%和2.18%。在混合感染中,PIV占83.32%(20/24),PIV3是最常见类型。同样,PIV和CoV占多重感染的100%,PIV3和CoVNL63是主要类型。冬、春两季RSV呈季节性变化,出现高峰。从5月到6月,HRV检测频率更高。2~5月间PIV感染季节性明显。除6月、7月和9月外,COV全年都有分布,没有明显的季节性。其他病毒性病原体在这一年中零星出现。结论研究表明呼吸道病毒是北京中医药大学孙思邈医院LRTI住院儿童的主要病因,RSV病毒检出率最高。这些发现有助于更好地了解病毒在不同年龄和季节的分布,并为当地疾控中心制定预防和控制LRTI策略提供参考。

Objective To determine the viral etiology and seasonal characteristics of lower respiratory tract infection (LRTI) in hospitalized children. Methods Clinical and demographic information and throat swabs were collected from 558 LRTI patients from January to December 2017. Multiplex RT-PCR was performed to detect the frequency and type of 16 common respiratory viral pathogens. Results Among the 558 patients,210 (37.63%) patients were positive for at least one pathogen. Single-infections accounted for 30.47%(170/558) of the cases,co-infections were found in 4.30%(24/558) and multiple infections were 2.87%(16/558). A total of 272 respiratory viral pathogens were identified from 210 patients. RSV was the most frequently detected (26.47%,72/272),followed by PIV (22.06%,60/272),HRV (21.32%,58/272),CoV (10.29%,28/272) and HAdV.(9.56%,26/272). FluA,hMPV and BoCA were 4.41%,3.72% and 2.18%,respectively. In the co-infections,PIV accounted for 83.32%(20/24)and PIV3 was the most frequently detected. PIV and CoV equally accounted for 100% of the multiple-infections. PIV3 and CoV NL63 were the predominant type. RSV showed seasonal variation with peaks during winter and spring. HRV was detected more frequently from May to June. Seasonality of PIV infection was apparent during February to May. CoVs were distributed throughout the year except in June,July and September and did not show obvious seasonality. Other viral pathogens appeared sporadically during the year. Conclusion This study demonstrated that respiratory viruses were the major cause of hospitalized LRTI children,and RSV was the most common type. These findings also gave a better understand of virus distribution among different age and seasons,which help to consider potential therapeutic approaches and develop effective prevention strategies for local CDC in drawing up further plans to prevent and control LRTI.