呼吸道病毒抗原检测在住院患儿呼吸道感染中的临床意义

The clinical significance of respiratory virus antigen detection in hospitalized children with respiratory infection

目的了解本地区呼吸道感染住院患儿的常见病毒感染情况及临床分布特征。方法收集2018年2月至2019年1月德阳市人民医院儿科住院的呼吸道感染患儿鼻咽拭子标本2051例,采用直接免疫荧光法对呼吸道合胞病毒(RSV),腺病毒(ADV),甲型流感病毒(IFV A),乙型流感病毒(IFV B),副流感病毒1、2、3型(PIV I、PIV II、PIV III)进行抗原检测,并分析患儿呼吸道病毒感染的流行特点、分布特征以及血常规变化等情况。结果共检出呼吸道病毒抗原阳性585例,总阳性率为28.52%,RSV阳性率(18.38%)明显高于其余6种病毒(P<0.01);大部分病毒在不同年龄段患儿的感染情况不同,新生儿期、婴儿期、幼儿期均以RSV阳性率(21.57%、26.23%、13.22%)最高(P<0.01),而学龄前期则以IFV A、IFV B阳性率(4.24%、4.24%)最高(P<0.01),婴儿期的总体病毒阳性率(35.68%)明显高于其余各期(P<0.01);RSV、IFV A、IFV B均在春冬季阳性率较高,而PIV III在冬季阳性率最低;病毒抗原阳性主要见于患儿下呼吸道感染,RSV、ADV、IFV A、PIV I、PIV II、PIV III均以引起支气管肺炎为主,而IFV B以引起急性支气管炎为主;除ADV感染外,其余6种病毒感染的患儿淋巴细胞/中性粒细胞(LYM/NEU)均明显升高(P<0.05)。结论本地区住院患儿呼吸道病毒感染以RSV为主,婴儿期是病毒感染的高发时期,根据LYM/NEU变化及早进行呼吸道病毒抗原检测可有效辅助临床诊疗。

Objective To investigate the common viral infections and clinical distribution characteristics of hospitalized children with respiratory infections in this area.Methods A total of 2051 nasopharyngeal swab specimens from children with respiratory tract infections from department of pediatrics of People′s Hospital of Deyang City from February 2018 to January 2019 were collected.Direct immunofluorescence was used to detect respiratory syncytial virus(RSV),adenovirus(ADV),influenza A virus(IFV A),influenza B virus(IFV B),parainfluenza virus types 1,2,3(PIV I,PIV II,PIV III)for antigen detection and the epidemiological characteristics,distribution characteristics and blood routine changes of children with respiratory viral infection were analyzed.Results A total of 585 positive cases of respiratory virus antigen were detected,with a total positive rate of 28.52%,and the positive rate of RSV(18.38%)was significantly higher than those of the other six viruses(P<0.01).Most of viruses had different infections in children of different ages.RSV infection was predominant in neonatal,infancy and early childhood(21.57%,26.23%,13.22%)(P<0.01),while IFV A and IFV B infection were predominant in preschool children(4.24%,4.24%)(P<0.01).The overall virus positive rate in infants(35.68%)was significantly higher than those in the other periods(P<0.01).RSV,IFV A,and IFV B all had higher positive rates in spring and winter,while PIV III had the lowest positive rate in winter.Respiratory virus antigen positive was mainly seen in children with lower respiratory tract infection.RSV,ADV,IFV A,PIV I,PIV II and PIV III mainly caused bronchial pneumonia,while IFV B mainly caused acute bronchitis in children.In addition to ADV infection,lymphocyte/neutrophil(LYM/NEU)was significantly elevated in the other six viral infections(P<0.05).Conclusions Respiratory virus infection in hospitalized children was mainly RSV.Infancy had a high incidence of viral infection.Early detection of respiratory virus antigen based on LYM/NEU changes could effectively assist clinical diagnosis and treatment.