病毒%重症监护病房,儿科%临床意义
病毒%重癥鑑護病房,兒科%臨床意義
병독%중증감호병방,인과%림상의의
Viruses%Intensive care units,pediatric%Clinical analysis
目的 探讨儿科重症监护病房患儿的病毒病原谱特点及其临床意义.方法 收集汕头大学医学院第二附属医院儿科重症监护病房患儿的咽拭子标本349份,同时收集该349例病例中因发热抽搐而需行腰椎穿刺术的患儿脑脊液标本130份,选取社区健康体检儿童87份咽拭子作为健康对照组.应用多重PCR技术,对咽拭子和脑脊液标本进行16种呼吸道病毒检测,同时应用荧光实时PCR技术,对脑脊液标本检测13种脑炎相关病毒,并对阳性病例的临床资料进行分析.结果 349份咽拭子标本中,病毒阳性209例(59.9％),其中鼻病毒117例,呼吸道合胞病毒60例,流感病毒A 20例,腺病毒10例,副流感病毒-3 6例,博卡病毒6例,流感病毒C5例,副流感病毒4 4例,冠状病毒HJYl/OC43 4例,流感病毒B3例,WU多瘤病毒3例,副流感病毒-l 2例,偏肺病毒2例,冠状病毒NL63/229E l例.87名健康儿童呼吸道病毒检测均为阴性.130例留取脑脊液标本的病例中,最后诊断为病毒性脑炎58例,病毒阳性22例(37.9％),其中肠道病毒通用型14例,巨细胞病毒3例,腮腺炎病毒2例,柯萨奇A16型l例,单纯疱疹病毒1例,鼻病毒1例.349例入选病例中,咽拭子和脑脊液病毒检测总阳性率为63.3％ (221/349).同一患儿检测到病毒混合感染45例(12.9％),占所有病毒阳性病例的20.4％.混合感染率最高为WU多瘤病毒(100％,3/3)和人偏肺病毒(100％,2/2).病毒阳性病例中,年龄＜6个月病毒感染率最高(72.2％),男性(148例)明显多于女性(73例).病毒阳性组中非危重病例少于病毒阴性组,而极危重病例则多于阴性组.结论 病毒是儿童重症感染性疾病的重要病原体,病毒感染可能导致病情加重,全面监测儿科重症监护病房病毒病原谱,对于提高感染性疾病诊断的准确性及治疗的针对性具有重要的临床意义.
目的 探討兒科重癥鑑護病房患兒的病毒病原譜特點及其臨床意義.方法 收集汕頭大學醫學院第二附屬醫院兒科重癥鑑護病房患兒的嚥拭子標本349份,同時收集該349例病例中因髮熱抽搐而需行腰椎穿刺術的患兒腦脊液標本130份,選取社區健康體檢兒童87份嚥拭子作為健康對照組.應用多重PCR技術,對嚥拭子和腦脊液標本進行16種呼吸道病毒檢測,同時應用熒光實時PCR技術,對腦脊液標本檢測13種腦炎相關病毒,併對暘性病例的臨床資料進行分析.結果 349份嚥拭子標本中,病毒暘性209例(59.9％),其中鼻病毒117例,呼吸道閤胞病毒60例,流感病毒A 20例,腺病毒10例,副流感病毒-3 6例,博卡病毒6例,流感病毒C5例,副流感病毒4 4例,冠狀病毒HJYl/OC43 4例,流感病毒B3例,WU多瘤病毒3例,副流感病毒-l 2例,偏肺病毒2例,冠狀病毒NL63/229E l例.87名健康兒童呼吸道病毒檢測均為陰性.130例留取腦脊液標本的病例中,最後診斷為病毒性腦炎58例,病毒暘性22例(37.9％),其中腸道病毒通用型14例,巨細胞病毒3例,腮腺炎病毒2例,柯薩奇A16型l例,單純皰疹病毒1例,鼻病毒1例.349例入選病例中,嚥拭子和腦脊液病毒檢測總暘性率為63.3％ (221/349).同一患兒檢測到病毒混閤感染45例(12.9％),佔所有病毒暘性病例的20.4％.混閤感染率最高為WU多瘤病毒(100％,3/3)和人偏肺病毒(100％,2/2).病毒暘性病例中,年齡＜6箇月病毒感染率最高(72.2％),男性(148例)明顯多于女性(73例).病毒暘性組中非危重病例少于病毒陰性組,而極危重病例則多于陰性組.結論 病毒是兒童重癥感染性疾病的重要病原體,病毒感染可能導緻病情加重,全麵鑑測兒科重癥鑑護病房病毒病原譜,對于提高感染性疾病診斷的準確性及治療的針對性具有重要的臨床意義.
목적 탐토인과중증감호병방환인적병독병원보특점급기림상의의.방법 수집산두대학의학원제이부속의원인과중증감호병방환인적인식자표본349빈,동시수집해349례병례중인발열추휵이수행요추천자술적환인뇌척액표본130빈,선취사구건강체검인동87빈인식자작위건강대조조.응용다중PCR기술,대인식자화뇌척액표본진행16충호흡도병독검측,동시응용형광실시PCR기술,대뇌척액표본검측13충뇌염상관병독,병대양성병례적림상자료진행분석.결과 349빈인식자표본중,병독양성209례(59.9％),기중비병독117례,호흡도합포병독60례,류감병독A 20례,선병독10례,부류감병독-3 6례,박잡병독6례,류감병독C5례,부류감병독4 4례,관상병독HJYl/OC43 4례,류감병독B3례,WU다류병독3례,부류감병독-l 2례,편폐병독2례,관상병독NL63/229E l례.87명건강인동호흡도병독검측균위음성.130례류취뇌척액표본적병례중,최후진단위병독성뇌염58례,병독양성22례(37.9％),기중장도병독통용형14례,거세포병독3례,시선염병독2례,가살기A16형l례,단순포진병독1례,비병독1례.349례입선병례중,인식자화뇌척액병독검측총양성솔위63.3％ (221/349).동일환인검측도병독혼합감염45례(12.9％),점소유병독양성병례적20.4％.혼합감염솔최고위WU다류병독(100％,3/3)화인편폐병독(100％,2/2).병독양성병례중,년령＜6개월병독감염솔최고(72.2％),남성(148례)명현다우녀성(73례).병독양성조중비위중병례소우병독음성조,이겁위중병례칙다우음성조.결론 병독시인동중증감염성질병적중요병원체,병독감염가능도치병정가중,전면감측인과중증감호병방병독병원보,대우제고감염성질병진단적준학성급치료적침대성구유중요적림상의의.
Objective To study the characteristics of viral spectrum and clinical features of children in pediatric intensive care unit (PICU).Method Nasopharyngeal aspirate specimens (NPA) from 349 patients(1 from each) and 130 cerebrospinal fluids (CSF) specimens were collected from children who were admitted to the PICU of Second Affiliated Hospital of Shantou University Medical College.Additional 87 NPA specimens were collected from healthy children for routine examination on the physical examination center,and the clinical data were collected.Multiplex PCR was applied to detect 16 kinds of viruses from NPA and CSF.Fluorescence quantitative PCR was applied to detect 13 viruses from CSF and to analyze the clinical data of positive cases.Result There were 209 samples (59.9％) of the 349 NPA specimens were positive for viruses,which included 117 cases positive for human rhinovirus (HRV),60 for respiratory syncytial virus (RSV),20 for influenza virus A (Inf A),10 for adenovirus (ADV),6 for parainfluenza virus type 3 (PIV-3),6 for human Boca virus (HBoV),5 for influenza virus C (Inf C),4 for parainfluenza virus type 4 (PIV-4),4 for human coronavirus-HKU1/OC43,3 for influenza virus B (Inf B),3 for WU Polyomavirus (WUPyV),2 parainfluenza virus type 1 (PIV-1),2 human metapneumovirus (HMPV) and 1 human coronavirus-NL63/229E.But none from 87 healthy controls were positive for any respiratory virus.Among the 130 CSF specimens,in 58 eases the diagnosis was viral encephalitis.There were 22 samples (37.9％) among the 58 CSF specimens positive for viruses,which included 14 enterovirus (EV),3 human cytomegalovirus (HCMV),2 mumps virus,1 coxsackie virus A16 (Cox-A16),1 herpes simplex virus (HSV) and 1 human rhinovirus (HRV).The total positive rate was 63.3％ (221/349).Co-infection by at least 2 viral pathogens under study was observed in 45 of the 349 patients (12.9％ of the total number of cases,20.4％ of the positives cases).The commonest pathogens in co-infected samples were WUPyV (100％) and HMPV(100％).The positive rate of virus peaked in the first 6 months of life,the rate in boys were higher than in girls and the peak season was summer.The numbers of none serious eases in the virus positive group were less than those in the virus negative group while the numbers of extremely serious cases in the virus positive group were higher than in the virus negative group.Conclusion Viral pathogen is a major cause of infectious disease in pediatric critical illnesses and virus infection may lead to severe illness.
