浙南地区下呼吸道感染儿童呼吸道合胞病毒基因型流行病学特征及与病情的关系  

Epidemiologic characteristics and the relationship with disease severity of respiratory syncytial virus genotypes from children with lower respiratory tract infection in the southern Zhejiang province

作　　者：董琳[1] 歹丽红 樊节敏[1] 陈小芳[1] 金小红[2] 张亚丽[3] 林海玲[3] 

机构地区：[1]温州医科大学附属第二医院育英儿童医院呼吸科,325027 [2]浙江省台州医院儿科 [3]浙江省丽水市中心医院儿科

出　　处：《中华儿科杂志》2015年第7期537-541,共5页Chinese Journal of Pediatrics

基　　金：浙江省省级公益性技术应用研究计划项目（2012C33049）;国家『临床重点专科开放基金项目（20140105）

摘　　要：目的 了解浙南地区呼吸道合胞病毒（RSV）基因型的流行病学特征,探讨其与儿童下呼吸道感染（LRTI）病情的关系.方法 收集2009年7月1日-2014年6月30日连续5个流行年度浙南地区3家三甲医院5岁以下因LRTI住院患儿的鼻咽部分泌物标本,采用直接免疫荧光法检测RSV抗原;每个流行年度随机抽取RSV阳性标本200份提取RNA,RT-PCR法检测RSV亚型,扩增G蛋白全基因序列并测序,同时收集RSV-LRTI患儿的临床资料,比较不同基因型感染的临床特点及疾病严重程度.结果 1 000份RSV阳性标本中检出A亚型462株（46.2％）,B亚型538株（53.8％）,其中2009-2010、2012-2014年度以B亚型为优势亚型,2010-2012年度以A亚型为优势亚型.测序得到112株RSV G蛋白基因序列,包括4种A亚型基因型（NA1、NA4、GA2、ON1）和6种B亚型基因型（BA8～10、BA-C、CB1和GB2）,其中A亚型以NA1最多（39/52,75.0％）,其次为ON1（10/52,19.2％）;B亚型以BA9最多（44/60,73.3％）,其次为BA8（6/60,10.0％）.除2010-2011年度外的4个年度B亚型的优势基因型均为BA9,除2013-2014年度外的4个年度A亚型的优势基因型均为NA1,2013-2014年度仅检出ON1和BA9基因型.39例NA1与44例BA9基因型感染患儿的平均疾病严重程度评分分别为4.154分和3.341分（U=642.500,P＜0.05）;两者的吸氧比例分别为33.3％和13.6％,差异有显著统计学意义（x2 =4.544,P＜0.05）,但两种基因型感染患儿在发病年龄、临床症状、入住ICU、住院时间及转归方面的差异均无显著统计学意义.结论 浙南地区2009-2014流行年度RSV亚型转换模式为B-A-A-B-B,存在多个基因型共循环;NA1和BA9是A、B亚型主要的优势基因型,NA1较BA9基因型感染病情严重,吸氧比例更高.Objective To investigate the epidemiological characteristics of respiratory syncytial virus （RSV） subtypes and genotypes in southern Zhejiang province,and to determine whether RSV genotypes are correlated with the disease severity of lower respiratory tract infection （LRTI）.Method Nasopharyngeal secretions （NPS） from children under 5 years of age who were hospitalized with LRTI during 5 consecutive seasons from July 1,2009 to June 30,2014 were collected.RSV antigen was determined using direct immunofluorescence （DIF）.Two hundred strains of RSV were randomly selected from each epidemic season.RNA was extracted and identified as subtype A or B by using reverse transcription-polymerase chain reaction （RT-PCR）,and randomly selected strains of the full length attachment （G） genes of both subtype A and subtype B were amplified by PCR and sequencing.Clinical data were collected,and the disease severity between different genotypes were compared simultaneously.Result Of the total 1 000 randomly selected RSV positive samples,462 （46.2%） and 538 （53.8%） samples were identified as subtype A and B,respectively.It was found that subtype B predominated in the 2009-2010 and 2012-2014 epidemic seasons and subtype A in 2010-2012 epidemic seasons.A total of 112 strains of complete sequences of G genes were obtained,including four subtype A genotypes NA1,NA4,GA2 and ON1,and six subtype B genotypes BA8-10,BA-C,CB1,and GB2.Phylogenetic analysis revealed that 39/52 （75.0%） subtype A strains were classified as NA1 genotype,followed by ON1 genotype （10/52,19.2%） and 44/60（73.3%） subtype B strains were classified as BA9 genotype,followed by BA8 genotype （6/60,10.0%）.BA9 was the predominant genotype among subtype B except 2010-2011 epidemic season,while NA1 was the predominant genotype among subtype A except 2013-2014 epidemic season.Only ON1 and BA9 genotypes were checked out during 2013-2014 epidemic season.There was statistically significant difference in the average severity score of illn

关 键 词：呼吸道合胞病毒 基因型 G蛋白 疾病严重程度指数 

分 类 号：R725.6[医药卫生—儿科]