2009年武汉地区甲型流感病毒血清学阳性儿童临床特征  

Clinical features of children infected with influenza virus A in year 2009 in Wuhan area

作　　者：魏聪[1] 黄媛[1] 郑昆[1] 赵东赤[1] 

机构地区：[1]武汉大学中南医院儿科,430071

出　　处：《中华实用儿科临床杂志》2014年第22期1696-1699,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 探讨武汉地区儿童甲型流感的流行季节、临床特征，以及多重病原感染的相关性。方法 收集2009年1月至12月有流感样症状住院患儿病例资料。所有患儿于入院后24 h内取静脉血，应用间接免疫荧光法检测呼吸道病原体血清IgM 抗体，除甲型流感病毒（Flu A）外，还包括呼吸道合胞病毒、腺病毒、乙型流感病毒、副流感病毒1，2，3型、肺炎支原体、肺炎衣原体、肺炎克雷伯杆菌（KP）、流感嗜血杆菌及肺炎军团菌。结果 599例流感样症状患儿中Flu A IgM 抗体的检出率为39.1%（234/599例），其年龄3～167个月，平均年龄为48.8个月。0～12个月患儿 Flu A IgM 的检出率（11.1% ，18/162例）明显较其他年龄组低（P 〈0.001），而6个月内婴儿的检出率为 1.43%（1/70例）。Flu A 抗体阳性组儿童与阴性组相比，临床以发热（78.2% ，183/234例，P =0.013）、咳嗽（76.5% ，179/234例，P =0.04）为主，较少出现呼吸道高反应如喘息（14.1% ，22/234例，P =0.003）和消化道症状（6.0% ，14/234例，P =0.001）。2009年全年均可检出Flu A IgM抗体，分别在5至6月和11至12月份出现2次峰值，检出率分别为 45.0% 和57.0% ，而同年1至3月和7至8月的检出率均 〈30.0% 。 〉12个月患儿混合感染明显增多，感染的组合趋于多样化，其中以 KP（53.8% ，126/234例）混合感染最为常见，Flu A阳性患儿中合并KP感染病例在临床特征上与KP阴性组比较差异无统计学意义。结论 Flu A主要感染1岁以上儿童；临床以发热、咳嗽为主，较少出现呼吸道高反应和消化道症状；武汉地区2009年全年均有FluA感染，流行高峰分别在5至6月及11至12月份。FluA儿童易合并KP等呼吸道病原体混合感染。Objective To explore the clinical and pandemic features and respiratory pathogen co-infection characteristics of children infected with influenza virus A （ Flu A） in year 2009. Methods A retrospective study of hos- pitalized children with flu-like clinical symptoms in 2009 was conducted. The peripheral blood serum was analyzed to detect common respiratory agents, including Flu A, respiratory syncytial virus, adenovirus,influenza virus B, parainfluen- za virus 1,2 and 3, chlamydia pneumonia and mycoplasma pneumonia, klebsiella pneumonia （KP） , haemophilus in- fluenza and legionella pneumophila by using indirect immunofluorescence test for the antibody detection （IgM）. And a standard medical history was recorded, including epidemiological data, clinical manifestation, and the length of hospital stay, white blood count and chest X-ray elsewhere. All specimens were collected in Department of Pediatrics, Zhongnan Hospital of Wuhan University,from Jan. 2009 to Dec. 2009. Results Flu A was detected in 234 of the 599 （39.1% , 234/599 cases） flu-like children. The mean age was 48.8 months （range from 3 to 167 months）. The detection rate in less than 1-year-old group （11.1% , 18/162 cases） was obviously lower than that of the older groups （P 〈 0. 001 ）. Es- pecially for the group 〈 6 months,there was only 1 infant （ 1.43% , 1/70 cases） with Flu A positive. Compared with Flu A negative group, the main clinical features of children with Flu A positive group were fever（78.2% , 183/234 ca- ses,P =0.013） and cough（76.5% ,179/234 cases,P =0.04）,however asthma （14.1% ,33/234 cases,P =0.003） and diarrhea （6.0% , 14/234 cases, P = 0. 001 ） cases were less. The detection rates of Flu A reached a peak of 57.0% in November and December, and a secondary peak of 45.0% in May and June. Flu A infection children less than 1 year old were simple in etiology. The children were older, the etiology was more complex. The primary coinfection pathogen was KP （53.8% ,126/234 cases） and Flu B�

关 键 词：甲型流感 儿童 呼吸道感染 混合感染 

分 类 号：R725.1[医药卫生—儿科]