2009-2016年广州市呼吸道合胞病毒感染的流行特征及临床特点分析

Epidemiology and clinical characteristics of respiratory syncytial virus infection in Guangzhou City,Guangdong Province from 2009 to 2016

目的分析急性上呼吸道感染患者中呼吸道合胞病毒(respiratory syncytial virus,RSV)的流行特征及临床特点。方法以南方医科大学珠江医院2009年11月至2016年6月收治的具有发热呼吸道症状患者为研究对象,采集鼻拭子标本3446份,提取标本RNA,采用qRT-PCR方法进行RSV检测,并对RSV阳性标本进行临床上常见的7种(14个亚型)呼吸道病毒的检测,以了解混合感染情况。结果共检测患者标本3446份,其中RSV阳性标本672份,总阳性率为19.5%。4个季节中RSV检出率差异具有统计学意义(χ2=133.184,P<0.001),并以春节最高,冬季次之,夏秋两季最少。RSV感染患者随着年龄的增长检出率逐渐降低,并以3岁及以下儿童检出率最高,占RSV阳性标本数的90.8%(610/672),儿童患者检出率明显高于成年患者(χ2=266.433,P<0.001),男性患者检出率明显高于女性患者(χ2=4.940,P=0.026),住院患者检出率明显高于门诊患者(χ2=60.433,P<0.001)。混合感染标本160份,其中双病毒感染标本143份,3种病毒混合感染16份,4种病毒混合感染1份,并以鼻病毒和呼吸道合胞病毒混合感染率最高,住院患者混合感染率高于门诊患者(χ2=20.896,P<0.001)。与非RSV感染者相比,RSV感染者咳嗽、咳痰、气促/呼吸困难等临床症状发生率均较高(χ2_(咳嗽)=108.934,χ2_(咳痰)=60.626,χ2_(气促/呼吸困难)=38.139,均P<0.001),而咽喉痛、头痛、乏力、寒战/畏寒和肌肉酸痛等发生率相对较低(χ2_(咽喉痛)=46.499,χ2_(头痛)=29.516,χ2_(乏力)=16.972,χ2_(寒战/畏寒)=9.616,χ2_(肌肉酸痛)=8.801,均P<0.001)。此外,RSV感染组与非RSV感染组在临床诊断上也存在统计学差异(χ2=212.157,P<0.001)。结论RSV是引起3岁以下儿童呼吸道病毒感染的主要病原体,也是引起3岁以下儿童呼吸道病毒感染住院的主要原因,咳嗽、咳痰及气促/呼吸困难的发生率较高,临床上应加强对该年龄段儿童的防护。

This study evaluated the clinical characteristics and epidemic characteristics of patients infected with human respiratory syncytial virus(RSV)in Guangzhou,China.A total of 3446 nose swab specimens collected from patients with respiratory tract infections at Zhujiang Hospital,Southern Medical University,Guangzhou,China,from November 2009 to June 2016,were analyzed.The RNA of the nose swab samples was extracted,and real-time quantitative reverse transcription PCR was used to detect the RSV.A total of 675 specimens were RSV positive,with a positivity rate of 19.3%.A statistically significant difference in the detection rate of RSV was observed among seasons(P<0.001):the highest detection rate were in spring,then winter,and the lowest detection rate were in summer and autumn.The RSV positivity rate of children gradually decreased with age:the positive detection rate was 90.5%in children 0-3 years of age.The RSV positivity rate was higher in children than adults(P<0.001);higher in males than females(P=0.049);and higher in inpatients than outpatients(P<0.001).A total of 160 RSV positive samples were co-infected with at least one other respiratory virus.A total of 143 samples had double coinfection,16 had triple coinfection,and one had quadruple coinfection.Among the coinfected specimens,rhinovirus and respiratory syncytial virus were most detected,and were significantly higher in hospitalized patients than outpatients(P<0.001).The clinical symptoms of sore throat,sputum,headache,fatigue,chills/chillness,muscle aches and shortness of breath/dyspnea showed differences between the RSV infection group and the non-RSV group(P<0.001).Children under 3 years of age were the most RSV infected group.Prevention measures should be strengthened for children of this age group,to decrease the hospitalization rate for RSV infection.