河南省住院儿童呼吸道腺病毒感染的临床和流行病学特征分析

Clinical and epidemiological characteristics of human adenovirus in hospitalized children with respiratory tract infections in Henan province

目的了解河南省住院儿童呼吸道腺病毒(human adenovirus,HAdV)感染的临床和流行病学特征,为本省腺病毒感染的诊断、检测及防治提供依据。方法选取2020年1月至2021年12月在郑州大学附属儿童医院住院的呼吸道感染病例样本17365例,应用呼吸道病原体的多重PCR检测或核酸双扩增法检测,收集呼吸道HAdV感染患儿的临床和实验室资料,分析患儿基本特征、流行病学特点、混合感染情况。结果HAdV感染2020年检出率3.19%,2021年为1.94%;一年四季均有检出,在2020年中1月检出率最高(5.98%),在2021年中7月检出率最高(4.46%)。HAdV感染主要发生在3岁~6岁(39.76%)。常见临床表现为发热(88.3%)、咳嗽(71.2%)、喘息(16.1%)。131例(32.0%)患儿伴有肺外症状,57例(13.9%)患有基础疾病,其中以先天性心脏病所占比例最高(22例,5.4%)。278例(67.8%)为单一感染,132例(32.2%)为混合感染,合并呼吸道合胞病毒感染比例最高37例(9.0%)。混合感染组住院天数、发热例数、热程、咳嗽例数、喘息例数、呼吸困难例数和重症病例数均明显高于单一感染组(P<0.05)。结论河南省腺病毒感染好发于3~6岁儿童,2020年为冬春季高发,2021年为夏季高发,临床表现以高热、咳嗽、喘息为主,肺外症状可出现呕吐、眼结膜出血、皮疹、惊厥。混合感染HAdV肺炎患儿更易出现发热、咳嗽、喘息、呼吸困难,更易进展为重症肺炎。

Objective To investigate the clinical and epidemiological characteristics of human adenovirus(HAdV)infection among hospitalized children with respiratory tract infections in Henan province.Methods A total of 17365 hospitalized cases of respiratory tract infection in the Children's Hospital Affiliated to Zhengzhou University from January 2020 to December 2021 were selected.Multiplex PCR detection of respiratory pathogens or double nucleic acid amplification method were used to detect respiratory tract pathogens.Clinical and laboratory data of children with respiratory HAdV infection were collected to analyze the basic information,epidemiological characteristics as well as co-infection of the children.Results The annual detection rates of HAdV infection was 3.19%and 1.94%in 2020 and 2021,respectively.HAdV infection could be detected all year round,with the highest detection rates in January 2020(5.98%)and in July 2021(4.46%).HAdV infection mainly occurred in children aged 3 to 6 years old(39.76%).Common clinical manifestations were fever(88.3%),cough(71.2%)and wheezing(16.1%).One hundred and thirty-one pediatric patients(32.0%)showed extrapulmonary symptoms,and 57 patients(13.9%)had underlying diseases,among which congenital heart disease accounted for the highest proportion(22 cases,5.4%).Single infection occurred in 278 cases(67.8%)while 132 cases(32.2%)had co-infection.The infection caused by respiratory syncytial virus accounted the highest proportion(37 cases,9.0%).The days of hospitalization,cases of fever,duration of fever and cases of cough,wheezing,dyspnea as well as severe cases in the co-infection group were significantly higher than those in the single infection group(P<0.05).Conclusions Adenovirus infection was common in children aged 3 to 6 years old in Henan province,with a high incidence in winter and spring of 2020 and in summer of 2021.The clinical manifestations were mainly high fever,cough and wheezing.Extrapulmonary symptoms may include vomiting,conjunctival hemorrhage,rash and convulsions.Children with co-infection of HAdV and pneumonia were more likely to have fever,cough,wheezing,dyspnea,and possible progressing to severe pneumonia.