沈阳地区儿童急性呼吸道感染常见病毒流行病学特征分析

Epidemiological analysis of common viruses causing acute respiratory infections in children in Shenyang area

目的分析沈阳地区急性呼吸道感染患儿常见病毒流行特点。方法选取2019-2022年本院接诊的782例急性呼吸道感染患儿为本次研究对象。在患儿未进行抗病毒药物治疗前采集患儿咽拭子标本。采用多重实时荧光PCR方法检测呼吸道合胞病毒(RSV)、副流感病毒(PIV)、人鼻病毒(HRV)、乙型流感病毒(IFVB)、甲型流感病毒(IFVA)、人腺病毒(HADV)、肠道病毒(EV)、冠状病毒(COV)、人偏肺病毒(HMPV)、人博卡病毒(HBOV)10种呼吸道感染常见病毒抗原。结果782例急性呼吸道感染患儿中,281例患儿病毒核酸检测阳性,阳性率35.93%。234例患儿为单一病毒感染,阳性率29.92%,主要为RSV、PIV感染。47例患儿为混合病毒感染,阳性率6.01%,主要为RSV+PIV混合感染。对比单一病毒阳性患儿组与病毒阴性组患儿的临床症状,单一病毒阳性患儿组发生发热、咳嗽发生率高于病毒阴性组患儿,差异有统计学意义(P<0.05)。两组患儿咳痰、咽喉疼痛、呼吸困难、呕吐、腹泻的发生率对比差异无统计学意义。感染IFVB、IFVA、HADV、EV、COV、HBOV患儿均出现发热症状,感染HADV、HBOV患儿发生咳嗽症状的发生率为100%,感染HADV患儿的发生咳痰症状的发生率为55%,感染COV患儿发生咽喉疼痛症状的发生率为30.77%,发生呕吐、腹泻的发生率为7.69%,感染HBOV患儿出现呼吸困难症状的发生率为20%,高于感染其他病毒患儿。急性上呼吸道感染患儿病毒阳性率46.05%,急性下呼吸道感染患儿病毒阳性率23.58%,差异有统计学意义(P<0.05)。急性上呼吸道感染患儿中HRV、IFVB、FIVA、EV的阳性率分别为7.21%、5.58%、4.65%、3.49%,高于急性下呼吸道感染患儿,差异有统计学意义(P<0.05)。春季发病患儿中病毒阳性率34.51%,夏季发病患儿中病毒阳性率16.39%,秋季发病患儿中病毒阳性率26.20%,冬季发病患儿中病毒阳性率46.75%,不同发病季节患儿,病毒阳性率差异有统计学意义(P<0.05)。冬季发病患儿中RSV、PIV、HRV、IFVA、HADV、混合感染的阳性率均高于其他季节发病患儿差异有统计学意义(P<0.05)。结论沈阳地区儿童急性呼吸道感染主要为单一病毒感染,以呼吸道合胞病毒、副流感病毒为主。急性上呼吸道感染患儿病毒阳性率高于下呼吸道感染患儿。儿童急性呼吸道感染多发病于冬季,冬季发病患儿的病毒阳性率高于其他季节发病患儿。

Objective The epidemic characteristics of common viruses in children with acute respiratory infections were analyzed in Shenyang area.Methods From 2019 to 2022,782 children with acute respiratory infection who were admitted to our hospital were selected for this study.The throat swab samples from the child were collected before receiving antiviral treatment.The lo common viral antigens of respiratory tract infection were detected by Multiple real-time fluorescent PCR,including respiratory syncytial virus(RSV),parainfluenza virus(PIV),human Rhinovirus(HRV),Influenza B virus(IFVB),Influenza A virus(IFVA),human adenovirus(HADV),Enterovirus(EV),coronavirus(COV),human metapneumovirus(HMPV),and human Bocaparvovirus(HBOV).Results Of 782 children with acute respiratory tract infection,281 were positive for virus Nucleic acid test detection,with a positive rate of 35.93%.234 children were infected with a single virus,with a positive rate of 29.92%,mainly RSV and PIV infections.47 children were infected with mixed viruses,with a positive rate of 6.01%,mainly RSV+PIV mixed infections.Comparing the clinical symptoms of the single virus positive group with the virus negative group,the incidence of fever and cough in the single virus positive group was higher than that in the virus negative group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of cough,sore throat,difficulty breathing,vomiting,and diarrhea between the two groups of children.Children infected with IFVB,IFVA,HADV,EV,COV,and HBV all experience fever symptoms.The incidence of cough symptoms in children infected with HADV and HBV was 1oo%,the incidence of sputum symptoms in children infected with HADV was 55%,the incidence of throat pain in children infected with COV was 30.77%,the incidence of vomiting and diarrhea was 7.69%,and the incidence of breathing difficulties in children infected with HBV was 20%,which was higher than that of children infected with other viruses.The positive rate of virus in children with acute Upper respiratory tract infection was 46.05%,and that in children with acute Lower respiratory tract infection was 23.58%.The difference was statistically significant(P<0.05).The positive rates of HRV,IFVB,FIVA and EV in children with acute Upper respiratory tract infection were 7.21%,5.58%,4.65%and 3.49%,respectively,which were higher than those in children with acute Lower respiratory tract infection,with a statistically significant difference(P<0.05).The virus positive rate in children with spring onset was 34.51%,in children with summer onset was 16.39%,in children with autumn onset was 26.20%,and in children with winter onset was 46.75%.The difference in virus positive rates among children with different onset seasons was statistically significant(P<0.05).The positive rates of RSV,PIV,HRV,IFVA,HADV,and mixed infection in children with winter onset were higher than those in children with other seasons onset,and the difference was statistically significant(P<0.05).Conclusion The main acute respiratory infections in children in Shenyang area were single virus infections,mainly respiratory syncytial virus and parainfluenza virus.The virus positive rate in children with acute upper respiratory tract infection was higher than that in children with lower respiratory tract infection.Acute respiratory tract infections in children were more common in winter,and the virus positivity rate of children with winter onset was higher than that of children with other seasons onset.