苏州地区住院患儿人副流感病毒3肺炎流行病学及临床特征研究

Epidemiology and Clinical Characteristics of Human Parainfluenza 3 Pneumonia in Hospitalized Children in Suzhou

目的:探讨苏州地区儿童人副流感病毒3肺炎的流行特点、临床特征及与气候因素的相关性。方法:收集2014-2017年苏州大学附属儿童医院收治的7525例社区获得性肺炎(CAP)住院患儿鼻咽分泌物,采用直接免疫荧光法检测人副流感病毒1、2、3型(HPIV1、HPIV2、HPIV3)、呼吸道合胞病毒(RSV)、腺病毒(ADV)及流感病毒A、B型(InfA、InfB),逆转录-聚合酶链反应(RT-PCR)检测人类偏肺病毒、人鼻病毒(HRV),实时PCR检测人博卡病毒;分析气候因素与HPIV3肺炎流行的相关性。结果:7525例患儿中,HPIV3阳性268例(3.56%),前3位检出的病毒分别是HRV、RSV、HPIV3。HPIV3肺炎主要临床表现为咳嗽(98.13%)、喘息(38.06%)、发热(46.64%)等。HPIV3肺炎好发于6~12月龄,春夏季高发;RSV肺炎好发于0~6月龄,秋冬季高发。高热在HPIV3肺炎中多见,而喘息、气促和重症在RSV肺炎中更多见。HPIV3检出率与月平均气温、月总雨量呈高度正相关(P<0.01),与月平均风速呈中度正相关(P<0.05)。结论:HPIV3是苏州地区CAP住院患儿第3位病毒病原,6~12月龄组检出率最高,春夏季为流行高峰,HPIV3检出率与月平均气温、总雨量呈高度正相关,与月平均风速呈中度正相关。

Objective:To probe into the epidemiology and clinical characteristics of human parainfluenza virus 3 pneumonia in children in Suzhou and its correlation with climatic factors.Methods:Nasopharyngeal secretions of 7,525 hospitalized children with communityacquired pneumonia(CAP)admitted into Children’s Hospital of Soochow University from 2014 to 2017 were collected.Human parainfluenza virus 1,2,3(HPIV1,HPIV2,HPIV3),respiratory syncytial virus(RSV),adenovirus(ADV)and influenza virus A,B(InfA,InfB)were detected by direct immunofluorescence.Human metapneumovirus and human rhinovirus(HRV)were detected by reverse transcription polymerase chain reaction(RT-PCR).Human bocavirus(HBoV)was detected by real-time fluorescent PCR.The correlation between climatic factors and the prevalence of HPIV3 pneumonia was analyzed.Results:Of the 7,525 cases,268 cases(3.56%)were positive for HPIV3,and the top 3 viruses detected were respectively HRV,RSV and HPIV3.The main clinical manifestations of HPIV3 pneumonia were cough(98.13%),wheezing(38.06%)and fever(46.64%).HPIV3 pneumonia was likely to occur at 6 to 12 months of age,and was more frequent in spring and summer;RSV pneumonia was likely to occur at 0 to 6 months of age,and was more frequent in autumn and winter.High fever was more common in HPIV3 pneumonia,while wheezing,shortness of breath and severe illness were more common in RSV pneumonia.The detection rate of HPIV3 was highly positively correlated with monthly average temperature and total monthly rainfall(P<0.01),and was moderately positively correlated with monthly average wind speed(P<0.05).Conclusion:HPIV3 is the third viral pathogen of CAP hospitalized children in Suzhou.The detection rate of HPIV3 is the highest at 6 to 12 months of age,and the epidemic peak is in spring and summer.The detection rate of HPIV3 is highly positively correlated with monthly average temperature and total monthly rainfall,and is moderately positively correlated with monthly average wind speed.