流感样病例流行病学特征及感染病原体类型调查

Epidemiological characteristics of influenza like cases and investigation of infection pathogen types

目的探讨流感样病例流行病学特征及感染病原体类型,为临床制定精准防控措施提供参考依据。方法选取本地区778例流感样病例(influenza like illness,ILI)为研究对象,采集患者鼻腔拭子或者咽喉拭子,全自动核酸提取仪提取拭子标本中总核酸,多重实时荧光PCR方法检测常见的10种呼吸道病毒。结果778例ILI呼吸道病毒总阳性率40.49%(315/778),其中单一病毒阳性率30.33%(236/778),两种混合病毒阳性10.16%(79/788)。单一病毒阳性中,主要为IFVA阳性、IFVB阳性、PIV阳性。两种混合病毒阳性中,主要为IFVA+IFVB阳性及IFVA+PIV阳性。病毒阳性患者中,临床症状主要为咳嗽(90.16%,284/315)、咳痰(50.16%,158/315)。病毒阴性患者中,临床症状主要为咳嗽(71.71%,332/463)。两组患者临床症状对比,咳嗽、流涕、咳痰、肌肉酸痛、胸痛、X线肺部异常差异有统计学意义(均P<0.05)。778例ILI中,男性402例,女性376例。男性总阳性率36.57%(147/402),单一病毒阳性标本主要为IFVA、IFVB、PIV,混合病毒阳性标本主要为IFVA+IFVB。女性总阳性率44.68%(168/376),单一病毒阳性标本主要为IFVA、RSV、IFVB,混合病毒阳性标本主要为IFVA+IFVB。不同性别患者,IFVA阳性率、RSV阳性率、总阳性率差异有统计学意义(均P<0.05)。778例ILI中,春、夏、秋、冬病例数分别为311、118、130和219例。春季患者阳性率48.55%(151/311),单一病毒阳性标本主要为PIV、RSV、IFVA,混合病毒阳性标本主要为IFVA+IFVB。夏季患者阳性率13.56%(16/118),单一病毒阳性标本主要为PIV,混合病毒阳性标本主要为IFVA+PIV、IFVA+RSV、IFVA+HRV。秋季患者阳性率19.23%(25/130),单一病毒阳性标本主要为IFVA、HRV,混合病毒阳性标本主要为IFVA+PIV。冬季患者阳性率56.16%(123/219),单一病毒阳性标本主要为IFVA、IFVB,混合病毒阳性标本主要为IFVA+IFVB。不同季节发病患者,IFVA阳性率、IFVB阳性率、PIV阳性率、RSV阳性率、HADV阳性率、IFVA+IFVB阳性率、总阳性率差异有统计学意义(均P<0.05)。结论本次研究流感样病例呼吸道病毒感染的病原体主要为IFVA、IFVB、PIV,不同性别、不同季节发病患者的病毒总阳性率及不同病毒构成情况具有一定差异性。

Objective The epidemiological characteristics of influenza like cases and the types of infectious pathogens were explored for providing reference for the development of precise prevention and control measures in clinical practice.Methods The 778 influenza like illness(ILI)cases in the local area were selected as the subject.The nasal or throat swabs were collected from patients.The total nucleic acid was extracted from swab samples by a fully automatic nucleic acid extractor.10 common respiratory viruses were detected by multiple real-time fluorescence PCR method.Results Among 778 cases of ILI,the total positive rate of respiratory viral pathogens was 40.49%(315/778),with a single virus positive rate of 30.33%(236/778)and a mixed double virus positive rate of 10.16%(79/788).In single virus positive,the main ones were IFVA positive,IFVB positive,and PIV positive.Among the two types of mixed virus positive,the main ones were IFVA+IFVB positive and IFVA+PIV positive.Among virus positive patients,the main clinical symptoms were cough(90.16%,284/315)and sputum(50.16%,158/315).Among virus negative patients,the main clinical symptom was cough(71.71%,332/463).The clinical symptoms of two groups of patients were compared,and there was a statistically significant difference in cough,runny nose,sputum production,muscle soreness,chest pain,and X-ray lung abnormalities(all P<0.05).Among 778 ILI cases,there were 402 male patients and 376 female patients.The total positive rate of male patients was 36.57%(147/402),and single virus positive specimens were mainly IFVA,IFVB and PIV.The mixed virus positive specimens were mainly IFVA+IFVB.The total positive rate of female patients was 44.68%(168/376),and single virus positive specimens were mainly IFVA,RSV and IFVB.The mixed virus positive specimens were mainly IFVA+IFVB.The difference of IFVA positive rate RSV positive rate and total positive rate in different genders was statistically significant(P<0.05).Among the 778 cases of ILI,the numbers of cases in spring,summer,autumn and winter were 311,118,130 and 219 respectively.The total positive rate of spring onset patients was 48.55%(151/311),with single virus positive specimens mainly being PIV,RSV,and IFVA,and mixed virus positive specimens mainly being IFVA+IFVB.The total positive rate of summer onset patients was 13.56%(16/118),with single virus positive specimens mainly being PIV and mixed virus positive specimens mainly being IFVA+PIV,IFVA+RSV,and IFVA+HRV.The total positive rate of autumn onset patients was 19.23%(25/130),with single virus positive specimens mainly being IFVA and HRV,and mixed virus positive specimens mainly being IFVA+PIV.The total positive rate of winter onset patients was 56.16%(123/219),with single virus positive specimens mainly being IFVA and IFVB,and mixed virus positive specimens mainly being IFVA+IFVB.The differences in the positive rate of IFVA,IFVB,PIV,RSV,HADV,IFVA+IFVB and total positive rate were statistically significant(all P<0.05).Conclusion The main pathogens causing respiratory virus infection in influenza like cases in this study were IFVA,IFVB,and PIV.The total positive rate of the virus and the composition of the virus varied among patients of different genders and seasons.