东莞市2017-2018年儿童下呼吸道感染病例监测结果

A surveillance of children lower respiratory tract infection cases in Dongguan City, from 2017 to 2018

目的利用液相芯片技术检测东莞地区儿童下呼吸道感染的病原体,获得病原谱流行病学特征,为临床的诊治提供可靠的依据。方法采集2017年11月至2018年10月在东莞市妇幼保健院住院的2 850例下呼吸道感染儿童的咽拭子标本,利用液相芯片技术进行13种呼吸道病原体的核酸检测,并对结果按照0~≤6月龄、>6~≤12月龄、>1~≤3周岁、>3~≤7周岁、>7周岁的年龄分组进行统计分析。结果 2 850例下呼吸道感染患儿中检出病原体阳性的有1 720例(60.35%),检出2种或2种以上病原体阳性的有533例(18.70%);在13种病原体中,检出率最高的前3种分别是呼吸道合胞病毒(RSV)661例(23.19%),肺炎链球菌(SP)629例(22.07%)和流感嗜血杆菌(Hi)282例(9.89%);而混合感染率排名前5的病原体分别是卡他莫拉菌(MC,98/119,82.35%)、鼻病毒(HRV,21/34,61.76%),流感嗜血杆菌(Hi,171/282,60.64%),人偏肺病毒(hMPV,44/75,58.67%)和肺炎链球菌(SP,357/629,56.76%)。各年龄组间感染的病原谱存在差异,低年龄段患儿中最常见的呼吸道病原体是RSV;SP和肺炎支原体(MP)的检出率随着年龄的增长呈现上升的趋势。检出率随季节变化较明显的病原体是SP、RSV、MC和Hi;SP的检出率在5-10月份间均维持在较高水平(>20%);RSV检出率在3月份有1个次高峰,在9月份达到最高峰;Hi检出率在5月份达到高峰;MC和MP的检出高峰期均是10-11月份。结论SP、RSV、MC和Hi在患儿中检出率存在明显的季节性变化;RSV、SP和MP在各年龄组的检出率存在差异;在临床诊疗活动中应注意病原体流行的季节变化、年龄组常见病原体差异以及多重病原体的感染。

Objective The liquid chip technology was used to detect the pathogens of children with lower respiratory tract infection in Dongguan,Guangdong province,and the epidemiological characteristics of pathogen spectrum were obtained,which provided a reliable basis for clinical diagnosis and treatment.Methods The throat swab specimens of 2850 children with lower respiratory tract infections who were hospitalized in Dongguan City Maternal and Child Health Hospital from November 2017 to October 2018 were collected. The nucleic acid of 13 respiratory tract pathogens was detected by liquid chip technology,and the results were analyzed statistically according to the age groups of 0~≤6 months,6~≤12 months,1~≤3 years,3~≤7 years and >7 years. Results Of the 2850 children with lower respiratory tract infection,1720(60.35%)were positive for pathgens,and 533(18.70%)were detected for two or more pathogens. Among 13 pathogens,The top three rates were 661(23.19%)of respiratory syncytial virus(RSV),629(22.07%)of Streptococcus pneumoniae(SP)and 282(9.89%)of Haemophilus influenzae(Hi). The top 5 pathogens with mixed infection rates were Moraxella catarrhalis(MC,98/119,82.35%),rhinovirus(HRV,21/34,61.76%),Haemophilus influenzae(Hi,171/282,60.64%),human metapneumovirus(hMPV,44/75,58.67%)and Streptococcus pneumoniae(SP,357/629,56.76%).The pathogen spectrum of infection among different age groups is different. The most common respiratory pathogen in children of low age is RSV;the detection rate of SP and Mycoplasma pneumoniae(MP)increases with age. The pathogens whose detection rate changed significantly with the season were SP,RSV,MC and Hi. The positive rate of SP maintained a high level(>20%)from May to October;the positive rate curve of RSV showed a sub-peak in March and peaked in September;the positive rate of Hi peaked in May;the positive rate of MC and MP peaked in October and November. Conclusion The detection rates of SP,RSV,MC and Hi in children showed significant seasonal changes. The detection rates of RSV,SP and MP were different in different age groups. In clinical diagnosis and treatment,attention should be paid to the seasonal changes of pathogens and the difference of common pathogens among age groups and multiple pathogen infections.