儿童呼吸道感染病原体分布及临床特征

Pathogen distribution and clinical characteristics of respiratory tract infections in children

目的了解安庆地区儿童常见呼吸道感染病原体的分布、临床特征,为及时诊断和治疗提供参考。方法统计安庆市第一人民医院2014年1月~2018年12月9 245例呼吸道感染患儿副流感病毒(PIV)、腺病毒(ADV)、呼吸道合胞病毒(RSV)、A型流感病毒(IFV-A)、B型流感病毒(IFV-B)、嗜肺军团菌(LP)、肺炎衣原体(CP)、肺炎支原体(MP)等8种常见呼吸道病原体分布情况,分析8种单病原感染的1 314例患儿的发病季节、年龄、性别、临床症状分布情况,并比较其血常规、肝功能指标。结果 9 245例患儿中,病原体感染以IFV-B、MP和IFV-A最多,分别占28. 8%、15. 7%和15. 2%。各病原体发病季节分布:PIV:冬、春季>夏、秋季;RSV:春、冬季>夏、秋季;IFV-A:春、冬季>秋、夏季;ADV:冬、春季>夏、秋季;CP:夏季>春季>秋、冬季;MP:秋季>夏季>春、冬季(P均<0. 050. 05)。各病原体感染年龄段分布:PIV:0~6个月、7~12个月> 4~6岁、13个月~3岁> 6岁以上(P均<0. 05);RSV:0~6个月、7~12个月> 13个月~3岁、4~6岁、6岁以上(P均<0. 05);IFV-A:13个月~3岁> 4~6岁、0~6个月> 7~12个月、6岁以上(P均<0. 05);ADV:0~6个月> 4~6岁、7~12个月> 13个月~3岁、6岁以上(P均<0. 05);CP:6岁以上> 4~6岁、13个月~3岁> 0~6个月、7~12个月(P均<0. 05);MP:13个月~3岁、4~6岁> 6岁以上、7~12个月> 0~6个月(P均<0. 05)。各病原体感染临床表现:发热占比:ADV最高、PIV最低;呼吸道有痰占比:IFV-A最高、RSV最低;鼻塞占比:最高ADV、最低LP;流涕占比:IFV-A最高,LP、ADV、CP最低;声嘶占比:ADV最高、MP最低;纳差占比:最高IFV-A、最低PIV;扁桃体肿大占比:最高LP,最低PIV;发生喘鸣音占比:RSV最高、LP最低;痰鸣音占比:最高RSV、最低CP(P均<0. 05)。血液学检查:中性粒细胞比例(NEUT%):CP最高、RSV最低;淋巴细胞比例:RSV最高、CP最低;血红蛋白:CP最高、RSV最低;血小板:ADV最高、CP最低;谷丙转氨酶(ALT):RSV最高,CP、MP最低(P均<0. 05)。结论儿童呼吸道感染的主要病原体为IFV-B、MP、IFV-A。呼吸道病原体感染类型与季节、年龄相关,RSV、PIV、ADV均以冬春季节多见,RSV感染的患儿发病年龄最小、半数以上为1岁以内婴儿,CP感染年龄最大,多为5岁以上儿童。ADV感染患儿发热、鼻塞、声嘶常见,RSV感染患儿喘鸣音和痰鸣音多见,IFV-A感染患儿主要临床表现为痰液、流涕。各病原体感染患儿NEUT%普遍较低、ALT较高。

Objective To investigate the epidemic characteristics and clinical features of respiratory tract infections in children in Anqing area,and to provide the basis for its prevention and treatment. Methods Serum specimens were collected from 9 245 children who were hospitalized with respiratory tract infections from January 1,2014 to December 31,2018. The serum specimens were conducted by indirect immunofluorescence for the detection of para-influenza virus( PIV),adenovirus( ADV),respiratory syncytial virus( RSV),influenza virus B( IFV-B),influenza virus A( IFV-A),leginonella pneumophila( LP),mycoplasma pneumoniae( MP),and chlamydia pneumoniae( CP). We analyzed the distribution of seasonality,age,sex,and clinical symptoms in 1 314 children with 8 single pathogen infections,and compared their blood routine and liver function indicators. Results Among the 9 245 children,the infection rates of IFV-B,MP,and IFV-A were 28. 8%,15. 7%,and 15. 2%,respectively. Seasonal distribution of pathogens: PIV: winter and spring> summer and autumn;RSV: spring and winter > summer and autumn;IFV-A: spring and winter > autumn and summer;ADV: winter and spring > summer and autumn;CP: summer > spring > autumn and winter;MP: autumn >summer > spring and winter( P < 0. 05). The age of distribution of pathogens: PIV: 0-6 months old and 7-12 months old> 4-6 years old and 13 months old-3 years old > more than 6 years old( all P < 0. 01);RSV: 0-6 months old and 7-12 months > 13 months old-3 years old and 4-6 years old and more than 6 years old( all P < 0. 01);IFV-A: 13 months old-3 years old > 4-6 years old and 0-6 months old > 7-12 months old and more than 6 years old( P < 0. 05);ADV: 0-6 months > 4-6 years old and 7-12 months > 13 months old-3 years old and more than 6 years old( P < 0. 01);CP: more than 6 years old > 4-6 years old and 13 months old-3 years old > 0-6 months old and 7-12 months old( P < 0. 01);MP:13 months old-3 years old and 4-6 years old > more than 6 years old and 7-12 months old > 0-6 months old( P < 0. 01).Clinical manifestations of pathogen infection: the fever ratio of ADV was the highest and PIV was the lowest( P < 0. 05);the proportion of sputum in respiratory tract was the highest in IFV-A and the lowest in RSV( both P < 0. 05);the nasal obstruction proportion was the highest in ADV and the lowest in LP( both P < 0. 05);IFV-A had the highest proportion of nasal discharge,followed by LP,ADV and CP( P < 0. 05);the proportion of hoarseness was highest in ADV and lowest in MP( P < 0. 05);the proportion of inappetence was the highest in IFV-A and the lowest in PIV( P < 0. 05);the proportion of tonsil enlargement was the highest in LP and the lowest in PIV( P < 0. 05);the proportion of wheezing was the highest in RSV and the lowest in LP( P < 0. 05);the sputum murmur ratio was the highest in RSV and the lowest in CP( P <0. 05). The distribution of hematologic examination: the proportion of neutrophils( NEUT%) was the highest in CP and the lowest in RSV( P < 0. 05);the proportion of lymphocyte( LYM%) was the highest in RSV and the lowest in CP( P <0. 05);the proportion of hemoglobin( HB) was the highest in CP and the lowest in RSV( P < 0. 05);the proportion of platelets( PLTs) was the highest in ADV and the lowest in CP( P < 0. 05);the proportion of alanine aminotransferase( ALT) was the highest in RSV and the lowest in CP and MP( P < 0. 05). Conclusions The main pathogens of respiratory tract infection in children in Anqing are IFV-B,MP,and IFV-A,and the incidence is related to season and age. The onset of RSV,PIV,and ADV is mostly seen in winter and spring. The RSV-infected children are the youngest,and more than half are infants( less than 1 year old),and CP-infected children are the oldest,and most of the children are over 5 years old and adults. The symptoms of ADV infection are fever,nasal secretions and hoarseness. The symptoms of RSV infection are wheezing and phlegm murmur. The symptoms of IFV-A infection are sputum and nasal secretions. NEUT% is generally lower and ALT is higher in children with various pathogen infections.