2007年至2014年北京地区儿童急性下呼吸道流感病毒感染临床分析  

Clinical analysis of influenza virus-associated acute lower respiratory tract infection in children in Beijing during 2007-2014

作　　者：朱云[1] 郭佳运 谢正德[1] 刘春艳[1] 任丽丽[5] 肖艳[1] 徐保平[2] 杨燕[3] 钱素云[4] 耿荣[4] 申昆玲[2] 

机构地区：[1]首都医科大学附属北京儿童医院,北京市儿科研究所病毒研究室,儿科学国家重点学科,省部共建儿科重大疾病研究重点实验室,100045 [2]中国医学科学院病原生物学研究所 [3]首都医科大学附属北京儿童医院儿科学国家重点学科呼吸内科 [4]首都医科大学附属北京儿童医院儿科学国家重点学科中医科 [5]首都医科大学附属北京儿童医院儿科学国家重点学科急救病房

出　　处：《中华实用儿科临床杂志》2015年第24期1883-1887,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家科学技术部项目（2013BA109811）;国家卫生计生委项目（2012ZX10004206-004）;北京市优秀人才培养资助青年骨干个人项目（2014000021469G23,）

摘　　要：目的 了解北京地区儿童急性下呼吸道感染（ALRTI）流感病毒（IFV）感染状况,比较儿童ALRTIIFV和呼吸道合胞病毒（RSV）的临床特征.方法 采集ALRTI患儿的咽拭子或鼻咽吸出物,利用多重反转录-聚合酶链反应检测方法检测RSV、副流感病毒、鼻病毒和IFV等.对A、B和C型IFV阳性病例进行分析,比较单纯IFV感染患儿与同期单纯RSV感染患儿的临床特征.结果 （1）2007年3月至2014年3月,共采集4 012份北京儿童医院收治的ALRTI患儿的呼吸道标本,2 697例标本病毒检测阳性（67.2％）,IFV标本256例（6.4％）,其中A型（IFA） 154例（3.8％）,B型（IFB）97例（2.4％）,C型（IFC）6例（0.1％）.（2）＜6个月、6个月-1岁、1-3岁、3-6岁和＞6岁年龄组中IFV检出率分别为4.1％、7.6％、12.0％、7.8％和4.8％,其中1-3岁组阳性率最高;男童与女童IFV总检出率差异无统计学意义（6.7％比5.9％,x2=2.63,P＞0.05）;冬春季为北京地区儿童流感病毒的流行高峰.（3）单纯IFA、单纯IFB和单纯RSV感染的ALRTI住院患儿分别为16例、15例和175例,单纯IFA感染组与单纯RSV感染组（43.8％比84.0％,x2=12.74,P＜0.001）和单纯IFB感染组与单纯RSV感染组（33.3％比84.0％ ,x2=19.11,P＜0.001）中＜1岁年龄患儿所占比例的差异有统计学意义.（4）单纯IFA和单纯IFB感染组重症肺炎的发生率高于单纯RSV感染组（31.2％、26.7％比4.0％,x2=18.49、13.01,P均＜0.001）,单纯IFA和单纯IFB感染组气管插管发生率高于单纯RSV感染组（25.0％、13.3％比1.7％ ,x2 =22.51、7.28,P＜0.001,P=0.001）,差异均有统计学意义,其他临床表现、诊断、机械通气的发生率和住院时间的差异均无统计学意义.结论 IFV是北京地区儿童ALRTI最主要的病毒病原之一,冬春季为儿童流感暴发的高峰期;低年龄组尤其是1-6岁的儿童更容易感染IFV,应作为流感防控的重点人群.ALRTI住院患儿单纯IFV感染与RSV感染的临�Objective To investigate the status of influenza virus （IFV） in children with acute lower respiratory tract infection （ALRTI） in Beijing, and to compare the clinical characteristics of ALRTI with single IFV and respiratory syncytial virus（RSV） in children.Methods Throat swab of nasopharyngeal aspirate specimens were collected from children with ALRTI and tested for the presence of respiratory viruses （such as RSV, parainfluenza virus, rhinovirus and IFV） by reverse transcription-polymerase chain reaction.The epidemiological features of patients with influenza A, B or C virus （IFA, IFB, IFC） infection were analyzed.Clinical features of patients with single IFV and single RSV infection were compared.Results （1） During March 2007 and March 2014 ,at least one virus was detected in 2 697 （67.2%）of4 012 children.There were 256 samples positive for IFV （6.4%） ,including 154 samples for IFA （3.8%） ,97 samples for IFB （2.4%） ,and 6 samples for IFC （0.1%）.（2） The IFV positive rate of 〈6 months,6 months-1 year, 1-3 years,3-6 years and 〉 6 years groups were 4.1% ,7.6%, 12.0% ,7.8% and 4.8%, respectively.The 1-3 years-old group showed the highest positive rate of IFV.The positive rate of IFV showed no difference between males and females（6.7% vs 5.9% ,x2 =2.63,P 〉0.05） （3） There were 16,15 and 175 hospitalized children in single IFV, single IFB and single RSV infection group, respectively.The rate of 〈 1-year children in single I FA （43.8% vs 84.0% ,x2 =12.74, P 〈 0.001 or IFB （33.3% vs 84.0% ,x2 =19.11, P 〈 0.001） infection group were both higher than it in single RSV infection group, and there was a significant difference.The incident rate of severe pneumonia in single IFA or IFB infection groups were both higher than that in single RSV infection group significant difference （31.2% ,26.7% vs 4.0%;x2 =1 8.49,13.01, all P 〈 0.001）.The incident rate of trachea cannula in single IFA and IFB infection groups were higher than in single RSV infection g

关 键 词：急性下呼吸道感染 流感病毒 呼吸道合胞病毒 临床特征 儿童 

分 类 号：R725.6[医药卫生—儿科]