上海地区住院患儿呼吸道合胞病毒相关急性下呼吸道感染的流行病学调查

Epidemiological study of respiratory syncytial virus-associated acute lower respiratory tract infection in hospitalized children in Shanghai

目的了解呼吸道合胞病毒(respiratory syncytial virus,RSV)相关急性下呼吸道感染(acute lower respiratory tract infection,ALRTI)住院患儿的流行病学特征及发生重症感染的危险因素。方法回顾性分析2013年1月至2018年12月复旦大学附属儿科医院收治的RSV相关ALRTI住院患儿流行病学和临床资料;并将2016年10月至2017年11月住院患儿中的随机抽取单数序列者分为重症感染组和非重症感染组,比较两组的流行病学和临床资料,采用多因素logistic回归分析重症RSV相关ALRTI的危险因素。结果34192例ALRTI住院患儿中,呼吸道病毒检测阳性者共8113例(23.73%),其中RSV 4028例(11.78%),高于其他被检测的常见呼吸道病毒;RSV感染者中年龄<6月龄者2550例(63.31%),<24月龄者3623例(89.95%);春、夏、秋、冬季的RSV检出率分别为6.47%(553/8551)、2.46%(176/7161)、12.85%(1042/8111)和21.77%(2257/10369)。347例RSV相关ALRTI患儿中,重症感染54例。多因素logistic回归分析显示,合并呼吸系统疾病(Z=3.43)、合并心血管疾病(Z=4.96)、非纯母乳喂养(Z=-1.97)、早产(Z=-1.98)为重症RSV相关ALRTI的独立危险因素(均P<0.050)。结论RSV是上海地区患儿发生ALRTI最重要和常见的病毒,6月龄以下婴儿最易感。合并呼吸系统疾病、合并心血管疾病、非纯母乳喂养和早产是重症RSV相关ALRTI患儿的高危因素。

Objective To investigate the epidemiological characteristics of hospitalized children with respiratory syncytial virus(RSV)-associated acute lower respiratory tract infection(ALRTI),and to analyzed the risk factors for severe infection.Methods The epidemiological and clinical data of hospitalized children with ALRTI and positive RSV test from Children′s Hospital of Fudan University from January 2013 to December 2018 were retrospectively analyzed.The hospitalized children from October 2016 to November 2017 were selected by random singular sequence and divided into severe infection group and non-severe infection group.The clinical data of the two groups were compared.Multivariate logistic regression analysis was used to analyze the risk factors of severe RSV-associated ALRTI.Results A total of 34192 hospitalized children were diagnosed with ALRTI,and 8113(23.73%)children were positive for respiratory tract viruses,including 4028(11.78%)children with RSV infection,which was higher than other common respiratory tract viruses.Among the 4028 RSV-positive children,2550(63.31%)were under six months of age,3623(89.95%)were under two years of age.The detection rates of RSV in spring,summer,autumn and winter were 6.47%(553/8551),2.46%(176/7161),12.85%(1042/8111)and 21.77%(2257/10369),respectively.In 347 hospitalized children with RSV-associated ALRTI,54 cases were severe cases.Multivariate logistic regression analysis showed that RSV-positive patients complicated with respiratory diseases(Z=3.43),cardiovascular diseases(Z=4.96),non-exclusive breast-feeding(Z=-1.97)and premature birth(Z=-1.98)were independent risk factors for severe RSV-associated ALRTI(all P<0.050).Conclusions RSV is the most important and common viral pathogen in hospitalized children with ALRTI in Shanghai,and infants under six months of age are the most susceptible to RSV.RSV patients complicated with respiratory diseases,cardiovascular diseases,non-exclusive breast-feeding and premature birth are more likely to develope severe RSV-associated ALRTI.