天津地区住院患儿鼻病毒感染的流行病学和临床特征分析

Epidemiology and clinical characteristics of human rhinovirus infection in hospitalized children in Tianjin

目的了解鼻病毒在天津地区急性呼吸道感染患儿中的检测情况、基因的遗传进化特征、流行趋势和临床特征,为临床诊疗提供理论依据。方法收集2017年7月至2019年12月在天津市儿童医院住院的急性呼吸道感染患儿的鼻咽抽吸物标本2945份,采用聚合酶链反应的方法筛选出鼻病毒阳性样本,VP4/VP2序列分析分型。将所获得的序列与已知的鼻病毒基因序列进行比对分析,并收集整理相关临床病例资料。采用SPSS 19.0比较不同季节和分型鼻病毒的检出结果。结果住院患儿鼻病毒阳性检出率为8.15%(240/2945),其中74.78%(86/115)被诊断为肺炎,40.83%(98/240)存在与其他常见病原菌混合感染;鼻病毒感染率冬季较低(4.14%,29/700),春秋季较高,分别为11.00%(66/660)和9.29%(81/872);分型以A型(50.00%,78/156)、C型(41.67%,65/156)居多,且10、11月检出率占C型阳性病例的46.15%(30/65);鼻病毒A型检出的主要分型依次为A12(11.54%,9/78),A49(6.41%,5/78),A22、A101、A66(均为5.13%,4/78)等;C型检出分型依次为C2(20.00%,13/65),C22(9.23%,6/65),C26、C43、C54、C53(均为4.62%,3/65)等;鼻病毒A型感染发热症状较C型常见(χ^(²)=5.411,P<0.05)。结论婴幼儿鼻病毒感染率高,有明显的季节流行趋势,常与其他病原菌混合感染,具有遗传多样性。

Objective To evaluate the prevalence of human rhinovirus(HRV)infection in hospitalized children in Tianjin and investigate the clinical impact of HRV infections.Methods From July 2017 to December 2019,2945 nasopharyngeal secretion specimens were screened for HRV using polymerase chain reaction(PCR).VP4/VP2 sequences of HRV were further characterized.The clinical characteristics of the HRV infection were analyzed.The detection results of HRV for different groups and different months were compared using SPSS 19.0.Results HRV-positive specimens accounted for 8.15%(240/2945),of which 74.78%(86/115)were diagnosed with pneumonia,40.83%(98/240)had co-infections with other common pathogens.HRV infections could be detected throughout the year with peaks in spring(11.00%,66/660)and autumn(9.29%,81/872).The positive rate of HRV was 4.14%(29/700)in winter.By VP4/VP2 sequence analysis,HRV-A was the most frequently detected strain(50.00%,78/156),followed by HRV-C(41.67%,65/156).46.15%(30/65)of HRV-C infections occurred in October and November.There were several different HRV-A types and HRV-C types.The most commonly detected HRV-A types were A12(11.54%,9/78),A49(6.41%,5/78),A22,A101,and A66(5.13%,4/78),etc.The most common HRV-C types were C2(20.00%,13/65),C22(9.23%,6/65),C26,C43,C54 and C53(4.62%,3/65).Patients with HRV-A infections are more likely to show fever symptoms than HRV-C(χ^(²)=5.411,P<0.05).No significant difference in other symptoms were found between the two types.Conclusions HRV was a commonly detected virus among infants and had a clear seasonal distribution.It′s also possible for the HRV patients to have co-infections with other pathogens.HRV showed high genetic diversity.