绍兴市4413例腹泻患儿中A组轮状病毒感染的流行及临床特征分析

Epidemiological and clinical characteristics of rotavirus group A infection in 4413 children with diarrhea in Shaoxing city

目的了解绍兴市腹泻患儿A组轮状病毒感染的流行特点及临床特征,为临床诊断与预防提供依据。方法回顾性分析2019年1月至2021年12月在绍兴市妇幼保健院就诊的4413例腹泻患儿相关临床资料;采集患儿粪便,采用A组轮状病毒(rotavirus group A,RVA)抗原检测试剂盒(胶体金法)进行病毒抗原检测,分析A组轮状病毒流行特征及患儿的临床特征。结果有796例腹泻患儿的粪便标本中A组轮状病毒抗原检测结果为阳性,总阳性率为18.04%(796/4413),2019年RVA检测阳性率(24.76%)最高,2020年(9.82%)和2021年(13.97%)RVA检测阳性率降低,各年份阳性率之间差异有统计学意义(χ^(2)=119.626,P<0.01);2019―2021年不同月龄腹泻患儿RVA阳性率均以12~<18月龄患儿RVA阳性检出率(分别为:34.45%,17.28%和19.51%)最高,不同月龄腹泻患儿RVA阳性率(6.11%~34.45%)差异有统计学意义(χ^(2)分别为45.597,16.049,18.302,P均<0.05);2019―2021年均以秋季的RVA阳性检出率(分别为:34.29%,17.04%和23.04%)最高,3年间不同季节阳性率(4.35%~34.29%)差异有统计学意义(χ^(2)分别为53.259,23.189,44.894,P均<0.01);同非A组轮状病毒感染患儿比较,A组轮状病毒感染的患儿有更为明显的低热(20.48%vs 7.35%,χ^(2)=128.027,P<0.01)、呕吐(88.07%vs 55.93%,χ^(2)=285.178,P<0.01)、脱水(6.66%vs 2.24%,χ^(2)=43.268,P<0.01)和呼吸道症状(17.96%vs 2.74%,χ^(2)=291.885,P<0.01),且粪便常规检验中白细胞检出率(9.05%vs19.27%)较低(χ^(2)=47.403,P<0.01)。结论A组轮状病毒是引起绍兴市低龄儿童腹泻的一个主要原因,12~<18月龄幼儿的阳性率最高,秋冬季为高发季节。

Objective To investigate the epidemiological and clinical characteristics of rotavirus group A(RVA)infection in children with diarrhea in Shaoxing,so as to provide evidence for clinical diagnosis and prevention.Methods The clinical data of 4413 children with intestinal infection who were diagnosed and treated in Shaoxing Women and Children's Hospital in the period from January 2019 to December 2021 were retrospectively analyzed.RVA antigen detection kit(colloidal gold method)was used to detect rotavirus in the stool samples collected from the children.The epidemiological characteristics of RVA infection and the clinical characteristics of the infected children were analyzed.Results A total of 796 stool samples from children with diarrhea were positive for RVA antigen,resulting in a total positive rate of 18.04%(796/4413).The positive rate was the highest in 2019(24.76%),and much lower in 2020(9.82%)and 2021(13.97%),with statistically significant difference across the years(χ^(2)=119.626,P<0.01).In all the three years,there were statistically significant differences in the positive rate across different age groups(6.11%—34.45%;χ^(2)=45.597,16.049,18.302 respectively,P all<0.05),and the highest positive rate was found in the age group of 12—<18 months(34.45%,17.28%,and 19.51% respectively in 2019,2020,and 2021).The positive rate in autumn(34.29%,17.04% and 23.04% respectively in 2019,2020 and 2021)was the highest in all the three years,and there were statistically significant differences across four seasons(4.35%—34.29%,χ^(2)=53.259,23.189,44.894 respectively,P all<0.01).Compared with non-RVA infected children,the children infected with RVA had more obvious symptoms of low fever(20.48%vs 7.35%,χ^(2)=128.027,P<0.01),vomiting(88.07%vs 55.93%,χ^(2)=285.178,P<0.01),dehydration(6.66%vs 2.24%,χ^(2)=43.268,P<0.01)and respiratory tract symptoms(17.96%vs 2.74%,χ^(2)=291.885,P<0.01),and lower detection rate of leukocytes in stool routine test(9.05%vs 19.27%,χ^(2)=47.403,P<0.01).Conclusions RVA is one of the main causes of diarrhea in young children in Shaoxing.The positive rate of RVA is the highest in children of 12—<18 months old,and autumn and winter are the peak seasons of RVA infection.