昆明地区婴幼儿病毒性腹泻流行病学特征及病毒致病特性分析

Epidemiological characteristics and main pathogenic characteristics of viral diarrhea in infants and young children in Kunming

目的了解昆明地区5岁以下腹泻婴幼儿轮状病毒(RV)、诺如病毒(NV)、腺病毒(ADV)和星状病毒(ASV)的感染情况及流行趋势,并对病毒的主要致病特性进行分析。方法收集2016年10月至2017年3月、2017年10月至2018年3月、2018年10月至2019年3月3个时段于云南省第一人民医院、昆明市儿童医院门诊就诊及住院治疗的2230例腹泻患儿(5岁以下)的粪便标本,采用酶联免疫吸附试验(ELISA)检测RV、NV、ADV和ASV抗原,同时收集患儿的性别,年龄,是否发热、呕吐,是否有呼吸道感染症状等临床资料。结果收集到的2230例患儿标本中,RV阳性标本684例,阳性率30.7%;NV阳性标本325例,阳性率14.6%;ADV阳性标本176例,阳性率7.9%;ASV阳性标本149例,阳性率6.7%;此外,检测到混合感染12例。3个时段中,ADV阳性率呈逐年上升趋势,ASV阳性率呈下降趋势,RV、NV的阳性率变化不明显。4种腹泻病毒主要以轻症腹泻为主,RV感染患儿发热比例略低且多合并呼吸道感染症状,而NV感染患儿发生呕吐的比例较高,ADV和ASV感染患儿多以腹泻为主,合并呕吐和呼吸道症状的比例较少。结论昆明地区引起婴幼儿腹泻的病毒以RV为主,其次为NV、ADV和ASV,混合感染以RV合并NV为主。4种病毒引起的腹泻多为轻症且较难区分,但结合发热、呕吐及呼吸道感染等相关临床症状可表现出一定的致病性差异。

Objective To understand the infection status and epidemic trends of Rotavirus(RV),Norovirus(NV),Adenovirus(ADV)and Astrovirus(ASV)in infants and young children under 5 years old with diarrhea in Kunming,and to analyze the main pathogenic characteristics of the viruses.Methods From October 2016 to March 2017,October 2017 to March 2018,October 2018 to March 2019,feces samples of children with diarrhea in the outpatient and inpatient departments of Yunnan First People′s Hospital and Kunming Children′s Hospital were collected.RV,NV,ADV and ASV antigens were detected using ELISA kits.At the same time,clinical datas of the children were collected,including gender,age,whether there were fever and vomiting,whether there were respiratory symptoms,etc.Results Of the 2230 feces samples,684 cases were positive for RV,and the positive rate was 30.7%;325 cases were positive for NV,and the positive rate was 14.6%;176 cases were positive for ADV,and the positive rate was 7.9%;149 cases were positive for ASV,and the positive rate was 6.7%.In addition,12 cases were detected as mixed infection.In the three periods,the detection rate of ADV showed an increasing trend year by year,ASV showed a downward trend,and the positive rate of RV and NV did not change significantly.The four types of diarrhea viruses were mainly mild diarrhea,the proportion of fever in RV was slightly lower,but mostly complicated with respiratory infections,and the proportion of vomiting in children with RV infection was higher.Diarrhea was the main symptom in children with ADV and ASV infection,with vomiting and respiratory tract symptoms.Conclusion The main pathogen in infants and young children with viral diarrhea in Kunming is RV,followed by NV,ADV and ASV.RV combined with NV infection is the most common mixed infection.The diarrhea caused by the four viruses is mostly mild and difficult to distinguish,but it can show certain pathogenic differences in combination with clinical symptoms such as fever,vomiting and respiratory infection.