呼吸道合胞病毒感染患儿临床及细胞因子特点

Clinical characteristics of children with respiratory syncytial virus infection and changes in cytokines

目的探讨呼吸道合胞病毒(Respiratory syncytial virus pneumonia,RSV)感染患儿临床特点及实验室指标变化。方法收集2018年1月-2020年1月新乡市中心医院收治的582例急性呼吸道感染患儿的临床资料,依据患儿是否存在RSV感染分为RSV感染组和非RSV感染组。同时根据RSV感染患儿病情程度分为轻度组和重度组。分析RSV感染患儿临床特点,比较各组实验室指标[白介素-17(IL-17)、肿瘤坏死因子-α(TNF-α)、α干扰素(IFN-α)、β干扰素(IFN-β)]水平,分析RSV感染程度与上述指标的关系。结果582例儿童共100例RSV感染,RSV感染率为17.18%(100/582)。RSV感染组发热、喘息、气促、胸片影像学表现为散在斑片状影、纹理增多占比明显高于非RSV感染组(P<0.05);100例RSV感染患儿,重度感染患儿38例(38.00%),轻度感染患儿62例(62.00%)。重度组、轻度组、非RSV感染组IL-17、TNF-α、中性粒细胞计数、IFN-α、IFN-β依次降低,而淋巴细胞计数依次增高,三组间比较差异有统计学意义(P<0.05);RSV感染患儿病情程度与IL-17、TNF-α、IFN-α、IFN-β、中性粒细胞计数呈正相关(P<0.05)。结论RSV感染患儿无明显性别、年龄、发病季节差异,以发热、喘息、胸片影像学表现为散在斑片状影、纹理增多等特点常见,RSV感染儿童病情程度与炎症反应和免疫功能低有关。

OBJECTIVE To explore the clinical characteristics of children with respiratory syncytial virus(RSV)infection and observe the changes of laboratory indexes.METHODS The clinical data were collected from 582 children with acute respiratory tract infection who were treated in Xinxiang Central Hospital from Jan 2018 to Jan 2020,the enrolled children were divided into the RSV infection group and the non-RSV infection group according to the status of RSV infection.The children with RSV infection were divided into the mild group and the severe group according to the severity of the infection.The clinical characteristics of the children with RSV infection were analyzed,the levels of laboratory indexes interleukin-17(IL-17),tumor necrosis factor-α(TNF-α),interferon-α(IFN-α)and interferon-β(IFN-β)were compared among the groups,and the relationship between the severity of RSV infection and the above indexes was analyzed.RESULTS Of the 582 children,100 had RSV infection,with the infection rate 17.18%(100/582).The proportions of the children who had fever,wheezing,shortness of breath,scattered patchy shadows and increased texture on chest radiographs were significantly higher in the RSV infection group than in the non-RSV infection group(P<0.05).Among the 100 children with RSV infection,38(38.00%)had severe infection,62(62.00%)had mild infection.The levels of IL-17,TNF-α,neutrophils,IFN-αand IFN-βof the severe group,the mild group and the non-RSV infection group were reduced in sequence,while,the lymphocytes counts were increased in sequence,and there were significant differences among the three groups(P<0.05).The illness condition of the children with RSV infection was positively correlated with the IL-17,TNF-α,IFN-α,IFN-βand neutrophils(P<0.05).CONCLUSION There are no significant differences in the gender,age and seasons among the children with RSV infection.Fever,wheezing,scattered patchy shadows and increased texture on chest radiographs are the common clinical characteristics.The illness condition of the children with RSV infection is associated with the inflammatory response and immune function.