人类博卡病毒感染的持续喘息患儿临床特点分析  

Clinical characteristics of 12 persistently wheezing children with human bocavirus infection

作　　者：邓昱[1] 刘恩梅[1] 赵晓东[1] 丁媛[1] 李渠北[1] 罗征秀[1] 王莉佳[1] 黄英[1] 杨锡强[1] 

机构地区：[1]重庆医科大学附属儿童医院呼吸内科,400014

出　　处：《中华儿科杂志》2007年第10期732-735,共4页Chinese Journal of Pediatrics

基　　金：重庆市卫生局重点项目[渝卫科教(2004)53号04-1-005];教育部新世纪优秀人才支持计划(NCET-06-0775)

摘　　要：目的探讨人类博卡病毒(HBoV)感染的持续喘息患儿临床特点。方法从2006年4月至2007年1月共收集39例持续喘息患儿的呼吸道分泌物标本,其中33例通过纤维支气管镜检查吸取下呼吸道分泌物,6例为鼻咽分泌物。先进行呼吸道常见7种病毒筛查,并采用 PCR 的方法检测HBoV 基因片段,对检出的阳性标本进行测序分析。结果 (1)用免疫荧光快速诊断的方法在39例持续喘息患儿呼吸道分泌物中共检出呼吸道合胞病毒阳性13例,腺病毒阳性9例,副流感病毒3阳性4例,流感病毒 A 阳性2例。对检出的13例 RSV 阳性的标本进行病毒分离培养后提取 RNA,RT-PCR 进行呼吸道合胞病毒检测,检出8例阳性。(2)PCR 和测序均证实,39例患儿呼吸道分泌物标本中有12例检出 HBoV 阳性。(3)12例 HBoV 阳性标本中的10例收集于冬春季,其余2例收集于夏秋季,与 RSV 的流行季节相似。(4)12例 HBoV 阳性患儿中7例出现发热,其中高热5例,明显高于RSV 感染的患儿(1/13),其胸 X 线改变出现间质性改变的例数也多于 RSV 感染患儿。其他如咳嗽、喘息、呼吸困难等临床表现两者差异均无统计学意义。结论 HBoV 感染是引起小儿下呼吸道感染的重要病毒病原之一,首次发现在持续喘息的患儿呼吸道分泌物中 HBoV 的阳性率高达31%。与RSV 感染的患儿相比,HBoV 感染发热例数相对多,但其他的临床症状与 RSV 相似。Objective The impact of human bocavirus （HBoV）, a newly identified human parvovirus, on childhood persistent wheezing has not been identified. In this study, the clinical features of infantile persistent wheezing induced by HBoV was analyzed. Methods Tracheal aspirates were collected by bronchofibroscope or nasopharyngeal （NP） aspirates from April, 2006 to January, 2007. HBoV was identified by PCR from 33 tracheal aspirates obatained by bronchofibroscope and 6 NP aspirates from children with persistent wheezing, who had at least or more than four weeks wheezing. RSV was identified by virus isolation in Hep-2 cells and antigen detetion by direct immunofluorescence assay （DFA） which was also used for diagnosis of adenovirus, influenza A and B, parainfluenza 1, 2, 3 infection. Results Of the 39 children with persistent wheezing, 12 cases （31%） were positive for HBoV DNA. Age of HBoV-positive patients ranged from 2 months to 1 year. The results of sequencing of PCR products proved that sequences of HBoV DNA from these 12 samples were exactly identical to those of HBoV stored in GeneBank （ accession numbers DQ000495 and DQ000496 ）. Two cases with HBoV infection were found to be co-infected with RSV. Ten of the 12 HBoV-positive samples were collected during the period from winter to spring （ 1 in November, 4 in December, 2 in January and 3 in April）, the other two HBoV-positive samples were collected during the period from summer to autumn （ 1 in May and the other in July）. Seven of the 12 HBoV DNA-positive patients had fever, 5 of them had high fever. Significantly more patients with HBoV infection had fever as compared to patients with RSV infection. All the HBoV positive patients showed abnormal findings on chest X ray such as interstitial infiltrates, lung infiltration and hyperinflation. Abnormal findings on chest X ray were found in higher proportion of HBoV positive patients as compared with RSV positive patients. And other manifestations such as wheezing, cough and respiratory distre

关 键 词：细小病毒科感染 哮喘持续状态 呼吸道感染 

分 类 号：R725.6[医药卫生—儿科]