沈阳市某医院收治的23490例疑似呼吸道感染患者外周血常见呼吸道病毒IgM抗体检测结果分析

Analysis of detection results of common respiratory virus IgM antibody in peripheral blood of 23490 pa⁃tients with suspected respiratory infection admitted to a hospital in Shenyang

目的探讨2017年—2020年各年度沈阳地区呼吸道病毒的流行特征,为临床诊疗提供依据。方法选择2017年—2020年在中国医科大学附属第四医院就诊的疑似呼吸道感染患者23490例,采集患者外周血,采用EILSA法检测血清A型流感病毒(AIV)、B型流感病毒(BIV)、副型流感病毒(PIV)、腺病毒(ADV)、柯萨奇病毒(COX)、人类巨细胞病毒(HCMV)、呼吸道合胞病毒(RSV)、EB病毒壳抗原(VCA)IgM抗体。收集患者临床资料,分析呼吸道病毒的流行病学特征。结果2017年—2020年间23490例患者中检出呼吸道病毒IgM抗体阳性5750例(24.49%,5750/23490)。PIV、COX、RSV、BIV、ADV、VCA、HCMV、AIV IgM抗体阳性率分别为7.26%(1706/23490)、4.01%(942/23490)、3.90%(916/23490)、3.52%(826/23490)、2.93%(688/23490)、1.76%(413/23490)、1.03%(241/23490)、0%(18/23490)。2017、2018、2019、2020年患者呼吸道病毒IgM抗体阳性率分别为24.16%(1495/6189)、29.09%(1909/6563)、22.98%(1663/7238)及19.51%(683/3500),两两比较,P均<0.05;不同年份间患者呼吸道病毒IgM抗体(AIV除外)阳性率比较,P均<0.05。男、女患者呼吸道病毒IgM抗体阳性率分别为24.14%(3035/12570)、25.3%(2763/10920),二者比较,P<0.05;但是单病毒IgM抗体阳性率比较,差异无统计学意义。0~≤3岁、4~≤6岁、6~≤18岁、19~≤65岁及65~≤105岁患者呼吸道病毒IgM抗体阳性率分别为16.36%(552/3375)、17.28%(345/1997)、18.08%(234/1296)、25.74%(2370/9209)、29.53%(2248/7613)。成年(年龄≥18岁)患者比未成年(年龄<18岁)患者呼吸道病毒IgM抗体阳性率高(P均<0.05)。且不同年龄层的易感病毒存在差异。春、夏、秋、冬季患者呼吸道病毒IgM抗体阳性率分别为25.78%(1448/5617)、26.2%(1335/5096)、22.4%(1289/5821)、24.2%(1676/6926);不同季节患者BIV、PIV、HCMV、RSVIgM抗体阳性率存在差异,P均<0.05。结论2017年—2020年沈阳地区门诊/住院患者呼吸道病毒感染的阳性率仍较高。沈阳地区门诊/住院患者的呼吸道病毒感染以PIV、COX、RSV、BIV、ADV感染为主。呼吸道病毒种类分布在呼吸道感染患者中不受性别影响,与年龄、季节、年份相关。2018年门诊/住院患者呼吸道病毒感染以RSV病毒感染为主,2019、2020年以EB病毒感染为主。成年患者呼吸道病毒感染比例较高。PIV感染主要集中在冬季,夏季较少发生;BIV感染秋季最低;HCMV感染春、秋季较少发生;RSV感染主要发生在春、夏。

Objective To investigate the epidemiological characteristics of respiratory virus in Shenyang from 2017 to 2020,and to provide evidence for clinical diagnosis and treatment.Methods A total of 23490 patients with suspected respiratory tract infection admitted to the Fourth Affiliated Hospital of China Medical University from 2017 to 2020 were selected and their peripheral blood was collected.EILSA was used to detect IgM antibodies to influenza A virus(AIV),influenza B virus(BIV),parainfluenza virus(PIV),adenovirus(ADV),Coxsackie virus(COX),human cytomegalovirus(HCMV),respiratory syncytial virus(RSV),and Epstein-Barr virus shell antigen(VCA).Clinical data of patients were collected to analyze the epidemiological characteristics of respiratory virus.Results From 2017 to 2020,5750(24.49%,5750/23490)positive respiratory virus IgM antibodies were detected in 23490 patients from 2017 to 2020.The positive rates of the IgM antibodies to PIV,COX,RSV,BIV,ADV,VCA,HCMV and AIV were 7.26%(1706/23490),4.01%(942/23490),3.90%(916/23490),3.52%(826/23490),2.93%(688/23490),1.76%(413/23490),1.03%(241/23490),and 0%(18/23490),respectively.The positive rates of the IgM antibodies to respiratory virus were 24.16%(1495/6189),29.09%(1909/6563),22.98%(1663/7238)and 19.51%(683/3500),in 2017,2018,2019,and 2020,respectively,with statistically significant differences(all P<0.05).There were statistically significant differences in the positive rates of the IgM antibodies to respiratory virus(except AIV)between patients from different years(all P<0.05).The positive rates of the IgM antibodies to respiratory virus were 24.14%(3035/12570)and 25.3%(2763/10920),in male and female patients,respectively(both P<0.05).However,there was no significant difference in the positive rate of each IgM antibody.The positive rates of the IgM antibodies to respiratory virus were 16.36%(552/3375),17.28%(345/1997),18.08%(234/1296),25.74%(2370/9209),and 29.53%(2248/7613)in patients of 0–≤3 years old,4–≤6 years old,6–≤18 years old,19–≤65 years old,and 65–≤105 years old,respectively.The positive rate of the IgM antibodies to respiratory virus in adult patients(age≥18 years)was higher than that in juvenile patients(age<18years)(P<0.05).And there were differences in susceptibilities to different viruses between different age groups.The positive rates of the IgM antibodies to respiratory virus were 25.78%(1448/5617),26.2%(1335/5096),22.4%(1289/5821),and 24.2%(1676/6926)in spring,summer,autumn and winter,respectively.The positive rates of the IgM antibodies to BIV,PIV,HCMV and RSV were different in different seasons(all P<0.05).Conclusions The positive rate of respiratory virus infection is still high in outpatients/inpatients in Shenyang from 2017 to 2020.PIV,COX,RSV,BIV and ADV are the main respiratory virus infections in Shenyang.The distribution of respiratory virus species is not affected by gender in patients with respiratory tract infection,but correlates with age,season and year.RSV virus is the main respiratory virus infection in outpatient/inpatient patients in 2018,and EPstein-Barr virus is the main respiratory virus infection in 2019 and 2020.The proportion of respiratory virus infection in adult patients is higher.PIV infection is mainly concentrated in winter and less in summer.BIV infection is lowest in autumn.HCMV infection occurs less in spring and autumn.RSV infection mainly occurs in spring and summer.