大理州某医院儿童急性下呼吸道感染病原学分析

Etiological characteristics of children with acute lower respiratory tract infection in a hospital of Dali Prefecture

目的 分析住院儿童急性下呼吸道感染(ALRTI)病原体感染情况及流行规律,为临床诊治和疾病预防控制提供参考。方法 选取2021-05-01-2022-04-30大理大学第一附属医院儿科住院部收治的402例临床诊断为ALRTI患儿作为研究对象,收集病例基本信息并采集呼吸道标本。采用多重实时荧光PCR技术对35种常见呼吸道病原体进行核酸检测,采用χ^(2)检验、Fisher精确概率法进行统计学分析。结果 402例ALRTI标本中,391例(97.26%)检出病原体,其中37例为单一感染,354例为多重感染。检出的主要病原体为肺炎链球菌(SP,82.34%),其次为流感嗜血杆菌(Hib,34.08%)、巨细胞病毒(CMV,23.63%)、呼吸道合胞病毒A型(RSV-A,20.40%)、呼吸道合胞病毒B型(RSV-B,19.40%)等。在不同年龄间,RSV-A、RSV-B、副流感病毒(PIV)、腺病毒(ADV)、CMV、EB病毒(EBV)、6型疱疹病毒(HHV-6)、7型疱疹病毒(HHV-7)、金黄色葡萄球菌(SA)、SP、Hib、鲍曼不动杆菌(ABA)、肺炎克雷伯杆菌(KPN)、肺炎支原体(MP)、肺炎衣原体(CP)检出率差异有统计学意义,均P<0.05。在不同季节间,RSV-A、RSV-B、PIV、乙型流感病毒(INFB)、鼻病毒(RV)、ADV、1型单纯疱疹病毒(HSV-1)、HHV-6、HHV-7、百日咳杆菌(B.pertussis)、CP检出率差异有统计学意义,均P<0.05。在不同民族间,除PIV(P=0.011)、INFB(P=0.004)外,其余病原体检出率差异无统计学意义,均P>0.05。在不同海拔间,仅229E型冠状病毒(CoV-229E)检出率差异有统计学意义,P=0.011。结论 本院儿童ALRTI的主要病原体为SP、Hib、CMV、RSV-A和RSV-B等;不同病原体检出率存在年龄、季节、民族及海拔的差异。

Objective To analyze the pathogen infection and epidemic rule of hospitalized children with acute lower respira-tory tract infection(ALRTI),so as to provide important reference for clinical diagnosis,treatment and disease prevention and control.Methods Totally 402 ALRTI cases were collected from May 1,2021 to April 30,2022 in the Pediatric In-patient Department of the First Affiliated Hospital of Dali University,and respiratory specimens were collected.Multiple real-time PCR was used to detect nucleic acids of 35 common respiratory pathogens.x^(2)test and Fisher exact test were used for statistical analysis.Results Pathogens were detected in 391(97.26%)of 402 ALRTI cases,including 37 cases of single infection and 354 cases of multiple infection.The main pathogens detected were streptococcus pneumoniae(SP,82.34%),followed by haemophilus influenzae serotype b(Hib,34.08%),cytomegalovirus(CMV,23.63%),respira-tory syncytial virus type A(RSV-A,20.40%),respiratory syncytial virus type B(RSV-B19.40%),etc.There were significant differences in the detection rate of RSV-A,RSV-B,parainfluenza virus(PIV),adenovirus(ADV),CMV,ep-stein-barr virus(EBV),human herpesvirus 6(HHV-6),human herpesvirus 7(HHV-7),staphylococcus aureus(SA),SP,Hib,acinetobacter baumanni(ABA),klebsiella pneumoniae(KPN),mycoplasma pneumoniae(MP)and chlamydia pneumoniae(CP)in each age group(all P<0.05).There was a statistically significant difference in the de-tection rates of RSV-A,RSV-B,PIV,influenza virus B(INFB),rhinovirus(RV),ADV,herpes simplex virus type 1(HSV-1),HHV-6,HHV-7,bordetella pertussis(B.pertussis)and CP among different seasons,all P<0.05.There was no significant difference in the detection rate of pathogens among different ethnic groups except PIV(P=O.011)and INFB(P=0.004).There was a significant difference in the detection rate of coronavirus 229E(CoV-229E)at different altitudes,P=0.01l.Conclusions SP,Hib,CMV,RSV-A and RSV-B are the main pathogens of acute respiratory infectious diseases in children at our hospital.The detection rate of different pathogens was different in age,season,nationality and altitude.