泉州地区儿童社区获得性肺炎病毒病原学调查

Viral etiology investigation of children community acquired pneumonia in Quanzhou area

目的:探讨泉州地区儿童社区获得性肺炎(CAP)的常见病毒病原学及人类偏肺病毒肺炎的感染现状。方法:2012年1月-2013年1月收治CAP患儿871例,收集深部鼻咽分泌物(NPS)标本,应用逆转录PCR的方法测定NPS中的人类偏肺病毒(HMPV),同时用直接免疫荧光法(DFA)检测NPS中的呼吸道合胞病毒(RSV)、流感病毒(IVA、IVB)、副流感病毒(PinfⅠ、Ⅱ、Ⅲ)、腺病毒(ADV),对各种病毒在儿童社区获得性肺炎中的流行特点及临床特征进行分析。结果:871例CAP患儿NPS标本中,检测病毒阳性313例,总检出率35.9%,其中RSV 189例(60.4%)、PinfⅢ53例(16.9%)、IVA 21例(6.7%)、HMPV 15例(4.8%)、IVB 13例(4.2%)、PinfⅠ11例(3.5%)、PinfⅡ6例(1.9%)、ADV 5例(1.9%)。<1岁与>l岁患儿RSV的检出率比较差异有统计学意义(χ2=473,P<0.001)。RSV的检出阳性率从3月起逐渐下降,7-8月达到最低,9月起检出率逐渐升高,至12月达到最高。HMPV致CAP全年可见,2-4月检出率最高,临床表现无特异性症状。本组患儿混合感染两种病毒12例,以RSV与PinfⅢ最常见;189例RSV感染病例中合并喘息153例(81.2%),15例HMPV感染病例中合并喘息5例(30%)。结论:病毒病原在泉州地区CAP占有重要地位,感染多见于<1岁婴幼儿,以RSV、副流感为主,HMPV也是引起CAP的重要病原之一。

Objective:To explore the common viral etiology and human metapneumovirus pneumonia infection status of children community acquired pneumonia(CAP) in Quanzhou area.Methods:871 children with CAP were selected from January 2012 to January 2013.Deep nasopharyngeal secretions(NPS) specimens were selected.Using reverse transcription PCR method measured human metapneumovirus(HMPV) in NPS.Using direct immunofluorescence(DFA) measured respiratory syncytial virus(RSV),influenza virus(IVA and IVB),parainfluenza(Pinf Ⅰ、Ⅱ、Ⅲ),adenovirus(ADV) in NPS.The epidemic characteristics and clinical features of a variety of viruses in children community acquired pneumonia were analyzed.Results:In NPS samples of 871 CAP children, the detection of the virus was positive in 313 cases,and the total detection rate was 35.9%,including 189 cases of RSV(60.4%),53 cases of Pinf Ⅲ(16.9%),21 cases(6.7%) of IVA,15 cases(4.8%) of HMPV,13 cases(4.2%) of IVB,11 cases(3.5%)of Pinf Ⅰ,6 cases(1.9%) of Pinf Ⅱ,5 cases(1.9%) of ADV.The detection rates of under 1 years old and above 1 years old RSV children were compared,and the difference was statistically significant(χ2=473,P<0.001).The detection positive rate of RSV from March gradually declined,from July to August reached the minimum,the detection rate from September increased gradually,December reached the highest.HMPV induced CAP visibled all year round,the detection rate was highest from February to April,the clinical manifestations had no specific symptoms.This group of children of mixed infection of two viruses in 12 cases,with the most common RSV and Pinf Ⅲ;189 cases of RSV infection with wheezing in 153 cases(81.2%),15 cases of HMPV infection with wheezing in 5 cases(30%).12 cases were mixed infection of two kind of virus in this group,RSV and Pinf Ⅲ were the most common.153 cases(81.2%) combined with wheezing in 189 cases of RSV infection,5 cases(30%) combined with wheezing in 15 cases of HMPV infection.Conclusion:Viral pathogen occupies an important position in Quanzhou area CAP.The infection is more common in infants and children under 1 years old.RSV and parainfluenza are mainly.HMPV is one of the important pathogenic that caused CAP.