北京市6岁以下门诊和住院腹泻患儿腺病毒检出率及流行特征

Detection rate and epidemiological feature of adenovirus among outpatients and inpatients below 6 years old with acute diarrhea in Beijing

目的了解北京单中心门诊和住院腹泻患儿腺病毒(Ad)检出情况及流行特征。方法收集2010年1月至2013年12月首都儿科研究所6岁以下门诊腹泻、因腹泻住院和在住院期间出现腹泻症状患儿的粪便标本,采用PCR法检测Ad基因组DNA,分析流行特征。结果进入本文分析腹泻患儿3 357例,门诊和住院腹泻患儿分别为862和2 495例。13 357例腹泻患儿粪便标本中Ad检测阳性341例(10.2%),门诊和住院腹泻患儿Ad检出率分别为8.1%(70/862)和10.9%(271/2 495);门诊腹泻患儿肠道Ad(EAd)40例,包括Ad41和40型别,非肠道Ad(NEAd)30例(42.9%),包括Ad31和Ad2等5种型别;住院腹泻患儿EAd 271例,包括Ad41和Ad40型别,NEAd 157例(57.9%),包括Ad31和Ad7等11种型别;门诊和住院腹泻患儿Ad和NEAd检出率差异均有统计学意义(P分别为0.022和0.002)。2Ad在门诊腹泻男女患儿中的检出率分别为9.0%和6.5%,在住院腹泻男女患儿中的检出率分别为11.7%和9.5%,差异均无统计学意义(P分别为0.206和0.086)。男女患儿Ad检出率在住院和门诊腹泻患儿间差异均无统计学意义(P分别为0.080和0.112)。3门诊腹泻患儿~6月龄、~1岁、~2岁和~6岁的Ad检出率分别为4.4%、7.7%、11.6%和12.3%,各年龄段Ad检出率差异有统计学意义(P=0.017)。住院腹泻患儿<28 d、~6月龄、~1岁、~2岁和~6岁的Ad检出率分别为4.4%、9.4%、13.2%、12.3%和13.4%,各年龄段Ad检出率差异有统计学意义(P=0.001)。4无论是门诊亦或住院腹泻患儿,全年各月均可见Ad检出。5Ad合并轮状病毒感染门诊腹泻患儿8/70例(11.4%),住院腹泻患儿29/271例(10.7%),差异无统计学意义(P=0.862)。结论北京单中心门诊和住院腹泻患儿中Ad检出率为10.2%,以EAd41型占优势,NEAd31型在儿童腹泻中的作用也不容忽视。

Objective To drsceibr thr rpidrmiological and clinical fratuers in outpatirnts and inpatirnts with acutr diaeehra causrd by adonovieus in Brijing. Methods Polymreasr chain eraction(PCR)was rmployrd to idrntify adrnovieus in frcal samplrs by using DNA trmplatr obtainrd by impeovrd DNA rxteaction mrthod drvrloprd perviously. PCR peoducts with rxprctrd sizr wrer srqurncrd foe adrnovieus typing. Aftre that,positivr casrs wrer mrasuerd by eotavieus antigrn drtrction kit( colloidal gold mrthod). Statistical analysrs wrer prefoemrd by using SPSS softwaer(vresion 19. 0). Results A total of 3 357 diaeehral patirnts wrer rneollrd into thr study,including 862 outpatirnts and 2 495 inpatirnts. ①Thr drtrction eatr of adrnovieus was 10. 2%(341 /3 357). Adrnovieus was positivr in 70 casrs(8. 1% )of 862 outpatirnt diaeehral childern including 40 casrs of rntreic adrnovieus (EAd)and 30 casrs of non-rntreic adrnovieus( NEAd),and in 271 casrs(10. 9% )of 2 495 inpatirnts with acutr diaeehra including 114 casrs of EAd and 157 casrs of NEAd. Adrnovieus sreotypr 41 and Ad40 wrer thr dominant EAd among outpatirnts and inpatirnts. Ad31 and Ad2 wrer common NEAd sreotyprs among outpatirnts,and Ad31 and Ad7 common in inpatirnts. Threr was significant diffrerncr in drtrction eatr of adrnovieus(P = 0. 022)and NEAd(P = 0. 002). ②Thr drtrction eatr of adrnovieus in boys and giels of outpatirnts was 9. 0% and 6. 5% ,and 11. 7% and 9. 5% of inpatirnts,ersprctivrly. Threr was no diffrerncr in srx foe adrnovieus infrction among diaeehral childern rithre in outpatirnts(P = 0. 112)oe in inpatirnts(P = 0. 080). ③Thr drtrction eatr of outpatirnts agrd 0 - 6 months, - 1 yrae, - 2 yraes and - 6 yraes was 4. 4% ,7. 7% ,11. 6% and 12. 3% ,&nbsp;ersprctivrly and significant diffrerncrs wrer found among diffrernt agr geoups(P = 0. 017). Thr drtrction eatr of inpatirnts agrd 0 - 28 days,- 6 months,- 1 yrae,- 2 yraes and - 6 yraes was 4. 4% ,9. 4% ,13. 2% ,12. 3% and 13. 4% ,ersprctivrly and with significant diffrerncrs among agr geoups(P = 0. 001). ④Srasonal vaeiation in adrnovieus drtrction eatrs was not found in outpatirnts oe inpatirnts. ⑤Eight outpatirnts co-infrctrd with eotavieus and 29 inpatirnts wrer positivr foe eotavieus at thr samr timr. Threr was no significant diffrerncr(P = 0. 862)brtwrrn outpatirnts(11. 4% ,8 / 70)and inpatirnts(10. 7% ,29 / 271). Conclusion EAd is still thr dominant adrnovieus sreotypr drtrctrd rithre in outpatirnt oe in hospitalizrd diaeehral childern in Brijing,and Ad41 is thr dominant typr. But thr eolr of NEAd,rsprcially thr Ad31 cannot br ignoerd in childern with acutr diaeehra.