878例副流感病毒在儿童社区获得性肺炎感染中的临床及流行特征分析

Clinical and Epidemiological Characteristics of 878 Cases of Parainfluenza Virus Infection in Children with Community-acquired Pneumonia

目的 分析人副流感病毒(HPIV)在社区获得性肺炎(CAP)患儿感染中的流行病学特点及临床特征,为临床诊治和提前预防提供理论依据。方法 采集2018—2019年银川市妇幼保健院878例CAP患儿的下呼吸道分泌物,运用多重PCR的方法检测HPIV-1、HPIV-2、HPIV-3、HPIV-4等呼吸道病毒,并分析CAP患儿感染的流行病学特点及临床特征。结果 878例患儿中总HPIV阳性率为35.1%,其中HPIV-3阳性率最高(25.5%),其次分别为HPIV-1(8.2%)、HPIV-2(4.8%)、HPIV-4(3.2%);HPIV-3患儿高发于0~3岁(P=0.044);HPIV-3在春、秋季高发(P<0.001);HPIV-1型感染的患儿咽部充血发生率较未感染者高(P=0.014),而感染HPIV-4的患儿肺部干湿啰音发生率较未感染者低(P=0.004),咳嗽、喘鸣音、咽部充血、呼吸困难等其他临床症状在HPIV各分型中差异均无统计学意义(P均>0.05);检出率最高的HPIV-3常合并细菌、支原体和其他病毒感染,合并感染的细菌以肺炎克雷伯菌(27.7%)、大肠埃希菌(17.0%)常见,合并感染的病毒以轮状病毒(42.0%)、呼吸道合胞病毒(RSV)(27.7%)常见,HPIV-3合并细菌感染者与未合并者相比,肺部干湿啰音发生率低(P=0.016);实验室指标中,HPIV-3感染者白细胞计数低于未感染者(P=0.035),而HPIV-3感染者红细胞计数高于未感染者(P<0.001),HPIV-3合并细菌感染者天冬氨酸氨基转移酶和丙氨酸氨基转氨酶均高于未合并细菌感染者(P均<0.05)。结论 HPIV是银川市妇幼保健院中CAP患儿的常见呼吸道病毒,HPIV-3感染最为常见,好发于婴儿期,主要集中在春、秋两季流行,常与其他病毒、细菌和支原体合并感染。

Objective To analyze the epidemiological and clinical characteristics of human parainfluenza virus(HPIV)infection in children with community-acquired pneumonia,providing theoretical basis for the prevention and treatment of respiratory infections.Methods Lower respiratory tract secretions from 878children were collected in Yinchuan Meternal and child Health Hospital from 2018—2019,and PCR was used to detect HPIV-1,HPIV-2,HPIV-3,HPIV-4 and other common respiratory tract pathogens.The epidemiological and clinical characteristics of CAP children were analyzed.Results The overall positive rate of HPIV in acute respiratory tract infection cases in 878 children was 35.1%,among which HPIV-3 was the highest,accounting for 25.5% of the total samples,followed by HPIV-1(8.2 %),HPIV-2(4.8%)and HPIV-4(3.2%).The incidence of HPIV-3 was higher in 0 to 3 years(P=0.044).The incidence of HPIV-3was higher in spring and autumn(P0.05).The highest detection rate of HPIV-3 was usually mixed with bacteria,mycoplasma and other viruses.Among bacteria,27.7% were co-infected with klebsiella pneumoniae,followed by 17.0% with Escherichia coli,while in other viruses,42.0% were co-infected with rotavirus,which was the most common virus,followed by 27.7% respiratory syncytial virus.HPIV-3 patients with bacterial infection were less likely to develop dry and wet pulmonary rales than those infected alone(P=0.016).Among laboratory indicators,the white blood cell count of HPIV-3-infected children was lower than that of uninfected children(P=0.035),while the red blood cell count of HPIV-3-infected children was higher than that of uninfected children(P=0.001).Aspartate transferase and alanine aminotransferase in HPIV-3 patients with bacterial infection were higher than those without bacterial infection(P all<0.05).Conclusion HPIV is a common respiratory virus in children with communityacquired pneumonia in Yinchuan meternal and chlid health hospital.HPIV-3 infection is the most common,with the peak incidence in infancy,and the epidemic mainly occurs in spring and autumn.It was often co-infected with other viruses,bacteria and mycoplasma.