2017-2019武汉地区学龄前儿童急性下呼吸道感染常见病原体流行特征分析

Epidemiological characteristics of common pathogens causing acute lower respiratory tract infection in preschool children in Wuhan from 2017 to 2019

目的分析近三年武汉地区急性下呼吸道感染住院学龄前患儿的呼吸道病原体感染情况及流行特点,为临床诊疗及流行病学调查提供依据。方法收集38479例于2017年3月-2020年2月在武汉儿童医院住院部诊断为急性下呼吸道感染学龄前患儿的血清,采用间接免疫荧光法检测9种呼吸道病原体:肺炎支原体(MP)、肺炎衣原体(CP)、嗜肺军团菌血清1型(LPl)、腺病毒(ADV)、Q热立克次体(COX)、呼吸道合胞病毒(RSV)、甲型流感病毒(INFA)、乙型流感病毒(INF-B)和副流感病毒1/2/3型(PIVS)IgM抗体。结果(1)在38479例住院急性下呼吸道感染学龄前患儿中,13855例至少检出一种病原体,检出率为36.01%,其中581例检出两种或以上病原体。以MP的检出率最高,为33.83%。其后依次为INF-B(0.88%)、RSV(0.57%)、ADV(0.22%)、LP1(0.17%)、PIVS(0.12%)、INF-A(0.12%)、CP(0.06%)、COX(0.03%)。男、女总检出率无统计学差异(P>0.05)。(2)各年龄组(<1岁、1-<3岁、3-<6岁)的总体检出率分别15.34%、53.41%、65.10%,组间差异有统计学意义(P<0.05)。除COX和CP外,其它7种病原体在不同年龄组检出率有统计学差异(P<0.05)。RSV在<1岁组检出率最高,随着年龄的增长检出率逐渐降低;ADV在1-<3岁组检出率最高;MP、LP1、INF-A、INF-B以及PIVS在3-<6岁组检出率最高。(3)除COX和CP外的7种呼吸道病原体存在季节易感性,在冬春季节检出率较高。(4)病原体混合感染的总检出率为1.51%,其中以MP合并其他病原体感染为主,占99.48%。最常见为MP+INF-B的混合感染。结论武汉地区学龄前儿童急性下呼吸道感染住院患儿的呼吸道病原体主要是MP;不同病原体具有不同的年龄分布及季节流行特征。

Objective Analyze the respiratory pathogen infection and epidemic characteristics of hospitalized preschool children with acute lower respiratory tract infection in Wuhan in recent three years,so as to provide basis for clinical diagnosis and epidemiological investigation.Methods Serum samples of 38479 preschool children with acute lower respiratory tract infection diagnosed in the inpatient department of Wuhan children’s Hospital from March 2017 to February 2020 were collected.Indirect immunofluorescence method was used to detect IgM antibodies of 9 respiratory pathogens:Mycoplasma pneumoniae(MP),Chlamydia pneumoniae(CP),Legionella pneumophila serotype 1(LP1),adenovirus(ADV),Q-fever rickettsia(COX),respiratory syncytial virus(RSV),influenza A virus(INF-A),influenza B virus(INF-B)and parainfluenza virus 1/2/3(PIVS).There was no significant difference between male and female(P>0.05).Results(1)Of the 38479 hospitalized preschool children with acute lower respiratory tract infection examined,13855(36.01%)were positive for at least one pathogen.Co-infections with two and three pathogens were found in 581 of the infected children.MP was the predominant pathogen(33.83%),followed by INF-B(0.88%)、RSV(0.57%)、ADV(0.22%)、LP1(0.17%)、PIVS(0.12%)、INF-A(0.12%)、CP(0.06%)and COX(0.03%).(2)The total detection rate of each age group(<1 year old,1-<3 years old,3-<6 years old)was 15.34%、53.41%and 65.10%respectively,with statistical significance(P<0.05).Except for Cox and CP,the detection rates of other 7 pathogens in different age groups were statistically different(P<0.05).The detection rate of RSV was the highest in<1-year-old group,and gradually decreased with the increase of age;The detection rate of ADV was the highest in 1-<3 years old group;MP,LP1,INF-A,INF-B and PIVS were the highest in the 3-<6-year-old group.(3)Except for Cox and CP,the other 7 respiratory pathogens had seasonal susceptibility,and the detection rate was higher in winter and spring.(4)The total detection rate of mixed infection of pathogens was 1.51%,MP combined with other pathogens accounted for 99.48%.The most common infection was MP+INF-B mixed infection.Conclusion MP is the main pathogen of acute lower respiratory tract infection in preschool children in Wuhan,and different pathogens have different age distribution and seasonal epidemic characteristics.