中华预防医学杂志
中華預防醫學雜誌
중화예방의학잡지
CHINESE JOURNAL OF
2013年
6期
497-503
,共7页
季伟%陈正荣%周卫芳%孙慧明%李蓓荃%蔡利红%严永东
季偉%陳正榮%週衛芳%孫慧明%李蓓荃%蔡利紅%嚴永東
계위%진정영%주위방%손혜명%리배전%채리홍%엄영동
呼吸道感染%急性病%儿童%病原学
呼吸道感染%急性病%兒童%病原學
호흡도감염%급성병%인동%병원학
Respiratory tract infections%Acute disease%Children%Etiology
目的了 解2005-2011年苏州地区急性呼吸道感染(ARI)住院患儿的病原检出情况.方法 选取苏州地区2005年9月至2011年10月因ARI在苏州大学附属儿童医院住院治疗的患儿作为研究对象,共10 243例.收集患儿临床资料,同时采集鼻咽部分泌物及血清标本进行多病原检测.应用直接免疫荧光法检测呼吸道合胞病毒(RSV)、流感病毒A(IV-A)和流感病毒B(IV-B)、副流感病毒1～3型(PIV-1 ～3)、腺病毒(ADV)；荧光定量PCR检测鼻咽分泌物中人类博卡病毒(HBoV)、肺炎支原体(MP)、肺炎衣原体(CP)；RT-PCR检测人类偏肺病毒(hMPV)；痰培养检测细菌；定量ELISA检测MP和CP的特异性抗体；分析病原检出情况、不同年龄患儿各病原检出率、各病原季节分布及其致病情况.结果 10 243例患儿中有5871例至少有1种病原检测结果为阳性,总检出率为57.32％ (5871/10 243),其中,病毒检出率为32.47％ (3326/10 243),细菌检出率为28.02％(2870/10 243),不典型病原体检出率为26.94％ (2759/10 243).MP是最常见的病原,检出率为25.74％(2637/10 243).病毒病原中RSV、PIV-3阳性患儿年龄中位数(分别为6、8月龄)小于患儿总体年龄中位数(12月龄)(x2值分别为380.992、34.826,P值均＜0.05),而ADV、HBoV、IV-A阳性患儿年龄中位数(分别为42、14、24月龄)高于总体年龄中位数(x2值分别为83.583、13.169、18.012,P值均＜0.05)；不典型病原MP患儿年龄中位数(30月龄)大于总体年龄中位数(x2=728.299,P＜0.05).细菌病原中肺炎链球菌和副流感嗜血杆菌阳性患儿年龄中位数(分别为17、21月龄)大于总体年龄中位数(x2值分别为60.463、8.803,P值均＜0.05).0～6月龄、7月龄～1岁、2～3岁、4～5岁、≥6岁组患儿RSV检出率分别为25.59％(840/3283)、17.05％(333/1953)、11.85％(310/2615)、6.68％(90/1347)、2.87％(30/1045),检出率随年龄的增长而下降(x2=178.46,P＜0.01)；各年龄组患儿MP检出率分别为8.25％(271/3283)、19.46％(380/1953)、33.00％(863/2615)、41.43％ (558/1347)、54.07％(565/1045),检出率随年龄增加而增加(x2=379.21,P＜0.01).RSV、IV-A好发于冬季,检出率分别为35.73％ (941/2634)和4.44％ (117/2634)；hMPV好发于冬春季节,春季为10.94％ (277/2533),冬季为10.55％ (278/2634)；HBoV好发于夏秋季节,夏季为9.99％(149/1491),秋季为9.71％(98/1009).MP、CP夏季检出率最高,分别达31.27％(819/2619)和10.07％ (43/427).毛细支气管炎以RSV最多见[33.27％(866/2603)]；支气管肺炎和大叶性肺炎均以MP检出最多,检出率分别为26.05％(1152/4422)和52.25％(267/511).结论 MP、RSV是住院儿童呼吸道感染常见病原.新型病毒hMPV和HBoV在儿童呼吸道感染中也起着重要的作用.不同的病原,年龄分布不同,具有各自的季节性及疾病分布特点.
目的瞭 解2005-2011年囌州地區急性呼吸道感染(ARI)住院患兒的病原檢齣情況.方法 選取囌州地區2005年9月至2011年10月因ARI在囌州大學附屬兒童醫院住院治療的患兒作為研究對象,共10 243例.收集患兒臨床資料,同時採集鼻嚥部分泌物及血清標本進行多病原檢測.應用直接免疫熒光法檢測呼吸道閤胞病毒(RSV)、流感病毒A(IV-A)和流感病毒B(IV-B)、副流感病毒1～3型(PIV-1 ～3)、腺病毒(ADV)；熒光定量PCR檢測鼻嚥分泌物中人類博卡病毒(HBoV)、肺炎支原體(MP)、肺炎衣原體(CP)；RT-PCR檢測人類偏肺病毒(hMPV)；痰培養檢測細菌；定量ELISA檢測MP和CP的特異性抗體；分析病原檢齣情況、不同年齡患兒各病原檢齣率、各病原季節分佈及其緻病情況.結果 10 243例患兒中有5871例至少有1種病原檢測結果為暘性,總檢齣率為57.32％ (5871/10 243),其中,病毒檢齣率為32.47％ (3326/10 243),細菌檢齣率為28.02％(2870/10 243),不典型病原體檢齣率為26.94％ (2759/10 243).MP是最常見的病原,檢齣率為25.74％(2637/10 243).病毒病原中RSV、PIV-3暘性患兒年齡中位數(分彆為6、8月齡)小于患兒總體年齡中位數(12月齡)(x2值分彆為380.992、34.826,P值均＜0.05),而ADV、HBoV、IV-A暘性患兒年齡中位數(分彆為42、14、24月齡)高于總體年齡中位數(x2值分彆為83.583、13.169、18.012,P值均＜0.05)；不典型病原MP患兒年齡中位數(30月齡)大于總體年齡中位數(x2=728.299,P＜0.05).細菌病原中肺炎鏈毬菌和副流感嗜血桿菌暘性患兒年齡中位數(分彆為17、21月齡)大于總體年齡中位數(x2值分彆為60.463、8.803,P值均＜0.05).0～6月齡、7月齡～1歲、2～3歲、4～5歲、≥6歲組患兒RSV檢齣率分彆為25.59％(840/3283)、17.05％(333/1953)、11.85％(310/2615)、6.68％(90/1347)、2.87％(30/1045),檢齣率隨年齡的增長而下降(x2=178.46,P＜0.01)；各年齡組患兒MP檢齣率分彆為8.25％(271/3283)、19.46％(380/1953)、33.00％(863/2615)、41.43％ (558/1347)、54.07％(565/1045),檢齣率隨年齡增加而增加(x2=379.21,P＜0.01).RSV、IV-A好髮于鼕季,檢齣率分彆為35.73％ (941/2634)和4.44％ (117/2634)；hMPV好髮于鼕春季節,春季為10.94％ (277/2533),鼕季為10.55％ (278/2634)；HBoV好髮于夏鞦季節,夏季為9.99％(149/1491),鞦季為9.71％(98/1009).MP、CP夏季檢齣率最高,分彆達31.27％(819/2619)和10.07％ (43/427).毛細支氣管炎以RSV最多見[33.27％(866/2603)]；支氣管肺炎和大葉性肺炎均以MP檢齣最多,檢齣率分彆為26.05％(1152/4422)和52.25％(267/511).結論 MP、RSV是住院兒童呼吸道感染常見病原.新型病毒hMPV和HBoV在兒童呼吸道感染中也起著重要的作用.不同的病原,年齡分佈不同,具有各自的季節性及疾病分佈特點.
목적료 해2005-2011년소주지구급성호흡도감염(ARI)주원환인적병원검출정황.방법 선취소주지구2005년9월지2011년10월인ARI재소주대학부속인동의원주원치료적환인작위연구대상,공10 243례.수집환인림상자료,동시채집비인부분비물급혈청표본진행다병원검측.응용직접면역형광법검측호흡도합포병독(RSV)、류감병독A(IV-A)화류감병독B(IV-B)、부류감병독1～3형(PIV-1 ～3)、선병독(ADV)；형광정량PCR검측비인분비물중인류박잡병독(HBoV)、폐염지원체(MP)、폐염의원체(CP)；RT-PCR검측인류편폐병독(hMPV)；담배양검측세균；정량ELISA검측MP화CP적특이성항체；분석병원검출정황、불동년령환인각병원검출솔、각병원계절분포급기치병정황.결과 10 243례환인중유5871례지소유1충병원검측결과위양성,총검출솔위57.32％ (5871/10 243),기중,병독검출솔위32.47％ (3326/10 243),세균검출솔위28.02％(2870/10 243),불전형병원체검출솔위26.94％ (2759/10 243).MP시최상견적병원,검출솔위25.74％(2637/10 243).병독병원중RSV、PIV-3양성환인년령중위수(분별위6、8월령)소우환인총체년령중위수(12월령)(x2치분별위380.992、34.826,P치균＜0.05),이ADV、HBoV、IV-A양성환인년령중위수(분별위42、14、24월령)고우총체년령중위수(x2치분별위83.583、13.169、18.012,P치균＜0.05)；불전형병원MP환인년령중위수(30월령)대우총체년령중위수(x2=728.299,P＜0.05).세균병원중폐염련구균화부류감기혈간균양성환인년령중위수(분별위17、21월령)대우총체년령중위수(x2치분별위60.463、8.803,P치균＜0.05).0～6월령、7월령～1세、2～3세、4～5세、≥6세조환인RSV검출솔분별위25.59％(840/3283)、17.05％(333/1953)、11.85％(310/2615)、6.68％(90/1347)、2.87％(30/1045),검출솔수년령적증장이하강(x2=178.46,P＜0.01)；각년령조환인MP검출솔분별위8.25％(271/3283)、19.46％(380/1953)、33.00％(863/2615)、41.43％ (558/1347)、54.07％(565/1045),검출솔수년령증가이증가(x2=379.21,P＜0.01).RSV、IV-A호발우동계,검출솔분별위35.73％ (941/2634)화4.44％ (117/2634)；hMPV호발우동춘계절,춘계위10.94％ (277/2533),동계위10.55％ (278/2634)；HBoV호발우하추계절,하계위9.99％(149/1491),추계위9.71％(98/1009).MP、CP하계검출솔최고,분별체31.27％(819/2619)화10.07％ (43/427).모세지기관염이RSV최다견[33.27％(866/2603)]；지기관폐염화대협성폐염균이MP검출최다,검출솔분별위26.05％(1152/4422)화52.25％(267/511).결론 MP、RSV시주원인동호흡도감염상견병원.신형병독hMPV화HBoV재인동호흡도감염중야기착중요적작용.불동적병원,년령분포불동,구유각자적계절성급질병분포특점.
Objective To elucidate the etiology of acute respiratory tract infection (ARI) in hospitalized children in Suzhou from 2005 to 2011.Methods A total of 10 243 hospitalized children with ARI in Children's Hospital Affiliated to Soochow University from September 2005 to October 2011 were enrolled in the study.The clinical information was collected; and the nasopharyngeal aspiration fluid and serum samples were sent for multi-pathogen detection.Respiratory syncytial virus (RSV),influenza virus type A and B (IV-A,IV-B),parainfluenza virus type 1-3 (PIV-1-PIV-3) and adenovirus (ADV) were detected by direct immunofluorescence assay.Human bocavirus (HBoV),mycoplasma pneunoniae (MP) and chlamydia pneumoniae (CP) were detected by fluorescent quantitative PCR while human metapneumovirus (hMPV) was detected by reverse transcription PCR (RT-PCR).Sputum culture was applied to detect bacterial infection and quantitative ELISA was adopted to detect the specific antibodies of MP and CP.The results of the above detections were analyzed,and thereby to explore the prevalent pathogens among different aging children and the seasonal distribution and characteristics of the disease.Results At least one type of pathogen was detected in 5871 out of 10 243 hospitalized children and the overall positive rate was 57.32％; including 3326 virus samples with positive rate at 32.47％ (3326/10 243),2870 bacteria samples with positive rate at 28.02％ (2870/10 243) and 2759 atypical pathogen samples,with positive rate at 26.94％ (2759/10 243).MP was the most common pathogen,whose detected rate was 25.74％ (2637/10 243).The median age of children with RSV (6 months) or PIV-3(8 months) infection was younger than the median age of all hospitalized children (12 months) (x2 =380.992,34.826,P ＜ 0.05).While the median age of children with ADV (42 months),HBoV (14 months) or IV-A (24 months)infection was older than it of all hospitalized children (x2 =83.583,13.169,18.012,P ＜ 0.05).The median age of children with MP (30 months),streptococcus pneumoniae (17 months) or haemophilus parainfluenzae (21 months) infection was older than it of all hospitalized children (x2 =728.299,60.463,8.803,P ＜ 0.05).The detected rate of RSV in the groups of children aging less than 6 months,7-12 months,2-3 years,4-5 years and over 6 years was separately 25.59％ (840/3283),17.05％(333/1953),11.85％ (310/2615),6.68％ (90/1347),and 2.87％ (30/1045) ; which decreased while the age grew (x2 =178.46,P ＜ 0.01).Conversely,the positive rate of MP increased with the age growing (x2 =379.21,P ＜ 0.01).The rate in the above groups was 8.25％ (271/3283),19.46％ (380/1953),33.00％ (863/2615),41.43％ (558/1347),54.07％ (565/1045),respectively.RSV and IV-A were prevalent in winter,whose detected rates were 35.73％ (941/2634) and 4.44％ (117/2634)respectively.hMPV infection was common in spring,with the detected rate at 10.55％ (278/2634) ; while HBoV infection was common in summer and autumn,with the positive rate at 9.99％ (149/1491) and 9.71％ (98/1009).MP and CP were frequently detected in summer,up to 31.27％ (819/2619) and 10.07％ (43/427) respectively.RSV was the most common pathogen in bronchiolitis (33.27％(866/2603)) and MP was the most common pathogen in bronchopneumonia (26.05％ (1152/4422)) and lober pneumonia (52.25 ％ (267/511)).Conclusion MP and RSV were the most common pathogens in respiratory tract infection in hospitalized children.The novel virus included hMPV and HBoV,which also played an important role in ARI.Different pathogens were prevalent in different ages; with respective seasonal distribution and characteristics.
