厦门市2426例呼吸道感染住院患儿常见病原学分析

Common etiological analysis of 2426 hospitalized children with respiratory tract infection in Xiamen City

目的 探究厦门市呼吸道感染住院患儿病原学特征和流行规律,分析儿童呼吸道感染病原体的发生情况,旨在为临床精准诊治提供依据。方法 回顾性分析2426例社区获得性呼吸道感染住院患儿的临床资料,取其上呼吸道(鼻咽)分泌物进行13项呼吸道病原体核酸检测,并分析13项呼吸道病原体阳性总体检出情况,不同年龄段、不同季节、不同性别的13项呼吸道病原体阳性检出情况。结果 2426例送检标本中病毒阳性总检出1473例,总阳性检出率为60.72%;其中人鼻病毒核糖核酸(RNA)最多(占27.77%),其余依次为甲型流行性感冒(流感)病毒RNA(占20.23%)、人偏肺病毒RNA(占17.04%)、呼吸道合胞病毒RNA(占16.77%)、季节性H3N2病毒RNA(占12.63%)、腺病毒DNA(占10.93%)、乙型流感病毒RNA(占10.39%)、副流感病毒RNA(占7.60%)、人博卡病毒DNA(占3.05%)、冠状病毒RNA(占1.09%)、甲型流感病毒H1N1(2009)RNA(占0.41%), 374例混合感染,阳性检出率为15.42%。1~3岁呼吸道病原体阳性总检出率最高(占64.39%),其余依次为<1岁(占60.04%)、4~6岁(占57.47%)、7~14岁(占54.97%);不同年龄段呼吸道病原体阳性总检出率及人鼻病毒RNA、人博卡病毒DNA、副流感病毒RNA、呼吸道合胞病毒RNA、季节性H3N2病毒RNA、甲型流感病毒RNA、人偏肺病毒RNA、腺病毒DNA、乙型流感病毒RNA阳性检出率比较,差异有统计学意义(P<0.05)。夏季呼吸道病原体阳性总检出率最高(占69.74%),其余依次为秋季(占59.29%)、冬季(占59.28%)、春季(占52.10%);不同季节呼吸道病原体阳性总检出率及人鼻病毒RNA、人博卡病毒DNA、副流感病毒RNA、呼吸道合胞病毒RNA、季节性H3N2病毒RNA、甲型流感病毒RNA、人偏肺病毒RNA、腺病毒DNA、乙型流感病毒RNA阳性检出率比较,差异有统计学意义(P<0.05)。结论 人鼻病毒、人偏肺病毒、甲型流感病毒及呼吸道合胞病毒是厦门市儿童呼吸道感染的最常见病原体,呼吸道感染儿童年龄以1~3岁(幼儿期)最为常见,各种病毒感染具有一定的季节特征;自2009年后甲型流感病毒H1N1(2009)在全世界爆发流行,虽然目前季节性流感进入常规监测,但其流行特征及变异规律仍需要持续监测和进一步研究。

Objective To investigate the etiological characteristics and epidemic regularity of children with respiratory tract infection in Xiamen City,analyze the occurrence of respiratory tract infection in children,so as to provide a basis for precise diagnosis and treatment.Methods A retrospective analysis was conducted in 2426 hospitalized children with community-acquired respiratory tract infection.13 respiratory tract(nasopharyngeal)secretions were collected for nucleic acid testing.The overall positive detection status of 13 respiratory pathogens was analyzed,as well as the positive detection status of 13 respiratory pathogens in different age groups,seasons,and genders.Results 2426 specimens were tested,among which 1473 were positive,and the total positive rate was 60.72%,in which human rhinovirus RNA was the highest(accounting for 27.77%),followed by influenza A virus RNA(accounting for 20.23%),human metapneumirus RNA(accounting for 17.04%),respiratory syncytial virus RNA(accounting for 16.67%),seasonal H3N2 virus RNA(accounting for 12.63%),adenovirus RNA(accounting for 10.93%),influenza B virus RNA(accounting for 10.39%),parainfluenza virus RNA(accounting for 7.60%),human bocavirus RNA(accounting for 3.05%),coronavirus RNA(accounting for 1.09%),influenza A virus/H1N12009 RNA(accounting for 0.41%),374 cases were mixed infection,accounting for 15.42%. The positive rate of respiratory pathogens was the highest in 1-3 year old group (64.39%), followed by <1 year old group (60.04%), the 4-6 year old group (57.47%), and the 7-14 year old group (54.97%). There was a statistically significant difference in total positive detection rates of respiratory pathogens and the positive detection rates of human rhinovirus RNA, human bocavirus RNA, parainfluenza virus RNA, respiratory syncytial virus RNA, seasonal H3N2 virus RNA, influenza A virus RNA, human metapneumirus RNA, adenovirus RNA, influenza B virus RNA among different age groups (P<0.05). The positive detection rate of respiratory pathogens was highest in summer (accounting for 69.74%), followed by autumn (accounting for 59.29%), winter (accounting for 59.28%), and spring (accounting for 52.10%). There was a statistically significant difference in total positive detection rates of respiratory pathogens and the positive detection rates of human rhinovirus RNA, human bocavirus RNA, parainfluenza virus RNA, respiratory syncytial virus RNA, seasonal H3N2 virus RNA, influenza A virus RNA, human metapneumirus RNA, adenovirus RNA, influenza B virus RNA in different seasons (P<0.05). Conclusion Human rhinovirus, metapneumovirus, influenza A virus and respiratory syncytial virus are the most common pathogens of respiratory tract infection in children in Xiamen City. The age of respiratory tract infection is 1-3 years old (early childhood). Various viral infections have certain seasonal characteristics. Since 2009, influenza A virus/H1N1 2009 has been circulating all over the world. Although seasonal influenza has been under routine surveillance, its epidemic characteristics and variation rules still need to be monitored continuously and further study.