儿童呼吸道腺病毒感染488例临床特征和流行病学分析

Clinical and epidemiological characteristics of respiratory adenovirus infections in children:analysis of 488 cases

目的:研究住院儿童呼吸道人腺病毒(HAdV)感染的临床和流行病学特征,为临床及时合理诊治提供参考依据。方法:回顾性分析2018年9月至2019年8月于浙江大学医学院附属儿童医院住院治疗的488例呼吸道HAdV感染患儿临床资料。所有鼻(咽)拭子或鼻咽抽吸物(NPAs)通过直接免疫荧光法检测。非正态分布计量资料采用Kruskal Wallis H检验,以P<0.05为差异有统计学意义。计数资料采用χ^(2)检验或Fisher确切概率法,组间率的比较采用Bonfereoniχ^(2)分割,校正后以P<0.007为差异有统计学意义。结果:7072例急性呼吸道感染病例中检测出488例HAdV感染,检出率6.9%,其中男性305例(62.5%)、女性183例(37.5%)。488例HAdV阳性患儿中位发病年龄为43个月(39 d~12岁),6个月~<2岁组HAdV检出率(8.7%,123/1408)高于<6个月组(3.0%,6/197)和≥5岁组(4.6%,89/1948),差异均有统计学意义(χ^(2)=7.57,23.98,P均<0.007);2~<5岁组检出率(7.7%,270/3519)高于<6个月组和≥5岁组,差异均有统计学意义(χ^(2)=5.809,19.688,P均<0.007)。冬季检出人数达峰值12.9%(238/1840),与春、夏和秋季检出率(4.7%、3.9%和5.5%)相比差异均有统计学意义(χ^(2)=103.477,58.986和49.926,P均<0.007)。平均住院时间(6±4)d(1~41 d),486例(99.5%)治疗后好转出院,2例死亡。上呼吸道感染111例(22.7%),支气管炎34例(7.0%),肺炎343例(70.3%),其中重症肺炎86例(86/343,25.1%)。常见症状为发热(93.4%,456/488)、咳嗽(94.7%,462/488)、喘息(26.2%,128/488)和气促(14.8%,72/488)。138例(28.3%)出现肺外症状,78例(16.0%)伴有基础疾病,其中先天性心脏病所占比例(16例,3.3%)最高。456例出现发热症状的HAdV阳性患儿平均热程(8.8±2.4)d(5~17 d),其中热程>7~10 d 277例、>10 d 96例;高热(≥39℃)439例。275例(56.4%)为单一感染,213例(43.6%)为混合感染。混合感染组患儿发热、高热、热程>10 d、重症肺炎和喘息比例以及住院天数均高于单一感染组,差异均有统计学意义(χ^(2)/Z=11.960、6.494、37.209、72.841和-8.805,P均<0.05)。HAdV感染重症肺炎组患儿住院天数、热程>10 d、喘息、气促、嗜睡/精神差、浆膜腔积液、肺外症状、混合感染和基础疾病比例均高于轻症肺炎组,差异均有统计学意义(χ^(2)/Z=-9.182、23.825、49.094、143.627、219.659、81.327、8.080、21.546和10.556,P均<0.05)。6个月~<2岁组重症肺炎比例高于2~<5岁和≥5岁组,差异均有统计学意义(χ^(2)=20.709,8.603,P均<0.007)。结论:HAdV是儿童急性呼吸道感染的重要病原,全年均可发病,可导致全呼吸道感染。好发于6个月~<2岁儿童,冬季检出率最高。6个月~<2岁、喘息、气促、基础疾病、肺外症状及混合感染患儿更易进展为重症肺炎。

Objective To investigate the clinical and epidemiological features of acute respiratory adenovirus infection in children.Methods Clinical data of 488 children with acute respiratory tract human adenovirus(HAdV)infection admitted in Children’s Hospital of Zhejiang University School of Medicine from September 2018 to August 2019 were retrospectively analyzed.Nasopharyngeal swabs or nasopharyngeal aspirates(NPAs)were collected and tested by direct immunofluorescence assay.Kruskal Wallis H test was used for quantitative data without normal distribution,and P<0.05 was considered to be statistically significant.The qualitative data were compared by chi-square test or Fisher’s exact test.Bonfereoni chi-square segmentation was performed for comparison between groups,and P<0.007 was considered statistically significant after correction.Results A total of 488 HAdV positive cases were detected from 7072 patients with acute respiratory tract infection(6.9%),including 305 males(62.5%)and 183 females(37.5%).The median age of HAdV positive children was 43 months(39 days to 12 years).The detection rate in 6 m-<2 y age group(8.7%,123/1408)was significantly higher than those in<6 m group(3.0%,6/197)and≥5 y group(4.6%,89/1948)(χ^(2)=7.57,23.98,P all<0.007).The detection rate in 2-<5 y group(7.7%,270/3519)was significantly higher than those in<6 m group and≥5 y group(χ^(2)=5.809,19.688,P all<0.007).The peak rate was detected in the winter[12.9%(238/1840)]which was significantly higher than those in spring(4.7%),summer(3.9%),and autumn(5.5%)(χ^(2)=103.477,58.986 and 49.926,P<0.007).The average length of hospital stay was(6±4)d(1-41 d).486 cases(99.5%)were discharged from hospital after treatment,and 2 cases died.There were 111 cases(22.7%)of acute upper respiratory tract infection,34 cases(7.0%)of bronchitis and 343 cases(70.3%)of pneumonia;and severe pneumonia was diagnosed in 86 cases(25.1%,86/343).The common clinical manifestations were fever 93.4%(456/488),cough 94.7%(462/488),wheezing 26.2%(128/488)and shortness of breath 14.8%(72/488).138 cases(28.3%)had extrapulmonary symptoms,78 cases(16.0%)had underlying diseases,among which congenital heart disease was most common(16,3.3%).The average duration of fever was(8.8±2.4)d(5-17 d)in 456 fever cases,the duration between 7-10 d in 277 cases and>10 d in 96 cases;and 439 cases had hyperpyrexia(≥39℃).The single infection occurred in 275(56.4%)cases and mixed infection in 213(43.6%)cases.The proportions of fever,hyperpyrexia,fever duration>10 d,severe pneumonia,wheezing and length of hospital stay in mixed infection group were significantly higher than those in the single infection group(χ^(2)/Z=11.960,6.494,37.209,72.841 and-8.805,P all<0.05).The length of hospital stay,proportion of fever time>10 d,wheezing,shortness of breath,hypersomnia/poor spirits,serous effusion,extrapulmonary symptoms,mixed infection,and underlying diseases in severe pneumonia group were significantly higher than those in the mild pneumonia group(χ^(2)/Z=-9.182,23.825,49.094,143.627,219.659,81.327,8.080,21.546 and 10.556,P all<0.05).The proportion of severe pneumonia in 6 m to<2 y group was higher than that in 2-<5 y group and≥5 y group(χ^(2)=20.709,8.603,P all<0.007).Conclusions HAdV is an important pathogen of acute respiratory infection in children.HAdV infection occurs mainly in children aged from 6 month to 2 years and has a high detection rate in winter.Children aged 6 months to 2 years with wheezing,shortness of breath,underlying diseases,extrapulmonary symptoms and mixed infections are more likely to develop severe pneumonia.