鼻病毒致儿童急性下呼吸道感染  

Human rhinovirus infection in children with acute lower respiratory tract infections

作　　者：奚志敏[1] 钟华清[2] 沈军[3] 王立波[1] 

机构地区：[1]复旦大学附属儿科医院呼吸科,上海201102 [2]复旦大学附属儿科医院儿科研究所,上海201102 [3]复旦大学附属儿科医院感染科,上海201102

出　　处：《中华传染病杂志》2015年第10期599-603,共5页Chinese Journal of Infectious Diseases

摘　　要：目的从肺泡灌洗液（BALF）中检测鼻病毒（HRV），以了解HRV致上海地区儿童社区获得性急性下呼吸道感染（ALRTI）的临床及分子生物流行病学特征。方法收集复旦大学附属儿科医院2014年1月至6月135例ALRTI住院患儿的BALF标本135份，并采集患儿临床信息。采用一步法实时荧光反转录PCR检测HRV，进一步检测HRV阳性株VP4／VP2衣壳蛋白基因序列，绘制基因进化树。阳性检出率及构成比的比较采用卡方检验。结果135份BALF中HRV阳性检出率为4．4％（6／135）。6例感染HRV患儿年龄为8个月～8岁，≤3岁5例。HRV阳性标本经扩增并测序后分析，结果4株为HRV—A，2株未知分型；4株HRV—A型内核苷酸同源性为76．5％～100．0％，分别与GenBank中的HRV—A、HRV—B和HRV—C参考株比较，核苷酸同源性分别为73．1％～91．7％、57．8％～66．0％和59．0％～65．0％。135例临床诊断为ALRTI的患儿中，普通肺炎124例，检出4株HRV（3．2％，4／124）；重症肺炎[合并呼吸衰竭和（或）心力衰竭]11例，检出2株HRV。HRV感染者临床均有高热、咳嗽表现，且以与其他病原体合并感染为主（5／6）。5例HRV感染患儿末梢血白细胞计数〈10×10^9／L，中性粒细胞比例〈0．50，C反应蛋白〈8mg／L，降钙素原〈0．05μg／L。所有HRV感染患儿均临床治愈。结论本研究在BALF中检测到HRV，提示HRV是本地区ALRTI病原体之一，且以HRV—A多见，HRV致病株VP4／VP2衣壳蛋白基因序列有高度变异的特性。Objective To investigate the clinical and molecular epidemiologic features of human rhinovirus （HRV） in children with acute lower respiratory tract infection （ALRTI） in Shanghai by detecting HRV from bronchoalveolar lavage fluid （BALF）. Methods One hundred and thirty-five BALF samples were collected from children with ALRTI at Childrenrs Hospital of Fudan University from January to June in 2014. The specimens were tested by one-step real-time reversible transcription （RT） polymerase chain reaction （PCR） for HRV. Gene fragments of VP4/VP2 capsid protein of the HRV genome were amplified and sequenced. The phylogenetic trees of HRV strains were drawn. Chi-square test was used for statistical analysis. Result Among these 135 samples, 6（4.4%） were HRV positive, including 4 positive for HRV-A and 2 positive for unknown genotype. The age of children with HRV positive was 8 months to 8 years, including 5 cases ≤3 years old. The nucleotide homology within 4 HRV-A samples varied 76. 5 %- 100.0 %. These 4 HRVA sequences were respectively compared with reference strains of HRV-A, HRV-B and HRV-C in GenBank. The nucleotide homology varied 73.1 %- 91.7%, 57. 8%-66. 0% and 59. 0%-65. 0%, respectively. Among 135 children with ALRTI, 124 were diagnosed with ordinary pneumonia including 4 （3.2 %, 4/124） HRV positive and 11 were diagnosed with severe pneumonia （with respiratory failure and/or heart failure） including 2 HRV positive. All children with HRV presented with fever and cough. Most of them （5/6） were co-infected with other pathogens. In 5 children with H RV positive, the peripheral blood leukocyte counts were less than 10 × 10^9/ L, neutrophil percentages were less than 0.50, C-reactive protein was less than 8 mg/L and proealcitonin was less than 0.05 gg/L. All the children were clinically cured. Conclusions The detection of HRV in BALF samples indicates that HRV is one of the pathogens in children with ALRTI in Shanghai and HRV-A is more common. Gene fragments of VP4/VP2 capsid prote

关 键 词：鼻病毒属 儿童 急性下呼吸道感染 支气管肺泡灌洗液 

分 类 号：R725.6[医药卫生—儿科]