诺如病毒和轮状病毒感染致小儿急性腹泻942例调查与临床分析  

Investigation and clinical analysis of norovirus and rotavirus infection in 942 children with acute diarrhea

作　　者：崔晓双 冯国双[2] 金芳[3] 徐樨巍[1] 

机构地区：[1]首都医科大学附属北京儿童医院北京市消化疾病中心消化科,北京100045 [2]首都医科大学附属北京儿童医院北京市消化疾病中心临床流行病与循证医学中心,北京100045 [3]首都医科大学附属北京儿童医院北京市消化疾病中心检验中心,北京100045

出　　处：《中国实用儿科杂志》2016年第8期603-607,共5页Chinese Journal of Practical Pediatrics

基　　金：十一五国家科技支撑计划课题(2012BA103B00)

摘　　要：目的与轮状病毒(RV)感染对比,了解诺如病毒(NV)感染的流行病学特点、临床特点及预后。方法 2012年11月至2013年10月,首都医科大学附属北京儿童医院选取3岁以下腹泻7 d以内婴幼儿的新鲜大便标本,筛选出无黏液、脓血的标本,应用胶体金免疫层析法检测NV及RV抗原。询问病史,依据Vesikari评分对腹泻严重程度进行评估,通过电话随访了解患儿预后。经统计分析,对NV及RV感染的流行病学特点、临床特点、预后进行对比研究。结果共入组942例,RV感染329例(34.9%),NV感染137例(14.5%),混合感染91例(9.7%)。RV感染存在明显的季节性,9月至次年2月为高发期;NV感染则全年散发。NV及RV感染在腹泻次数、腹泻持续时间、呕吐持续时间上均无统计学差异,但RV感染中,发热、呕吐、严重腹泻(伴有乏力、嗜睡、精神弱等症状)的比例明显高于NV感染(P<0.05),而流涕、咳嗽症状在NV感染更常见。NV感染Vesikari评分均值为(8.98±2.94)分,低于RV[(10.45±3.04)分,P<0.05)]。NV及RV感染多7 d以内好转,但NV感染易出现病程迁延。结论 RV仍为婴幼儿急性腹泻的主要病原,但NV感染检出率亦较高;NV感染呈全年散发,RV感染仍呈秋冬季节高发;RV感染出现发热、呕吐、严重腹泻较NV常见,而NV感染多伴呼吸道症状且病程易迁延。Objective To explore the epidemiological features of NV and RV infection and to investigate the clinical features and prognosis of NV infection. Methods Stool specimens （without pus, mucus or blood） were collected from children less than 3 years old with acute diarrhea within 7 days admitted from November 2012 to October 2013 in Bei- jing Children＇ s Hospital, Capital Medical University. Stool specimens were screened for N~ and RV using immunochro- matographic test （ICG）. History was investigated and the severity was evaluated by Vesikari scale. Follow-ups were con- ducted via phone calls. The epidemiological features, clinical manifestations and prognosis of children infected with NV were analyzed and compared with those infected with RV. Results Among the total 942 samples, RV was detected in 329 （ 34.9% ） samples, while NV was detected in 137 （ 14.5% ） samples. Rate of co-infection was 9.7% （ 91/942 ）. The sea- sonal distribution of RV detection showed a peak of incidence from September to February the following year, but NV detection showed sporadic distribution. The times and duration of diarrhea and vomiting were similar in two kinds of infection, but fever, vomiting, severe diarrhea （with fatigue, sleepiness or lethargy） were significantly more common in RV infection （P〈0.05）. NV infection had a higher incidence of respiratory symptoms, such as cough and rhinorrhea. Mean Vesikari severity score was （8.98± 2.94） in NV infection, remarkably lower than （10.45± 3.04）in RV infection （P 〈0.05）. Most patients recovered in 〈 7 days, but NV infection was likely to have longer duration. Conclusion RV is still the leading cause of acute viral diarrhea, and NV is also a significant cause. NV infection occurs year- round, while RV infection shows a peak in autumn and winter. Fever, vomiting and severe diarrhea with dehydration are more common in RV infection. NV infection has a high- er rate of respiratory symptoms and longer recovery period.

关 键 词：诺如病毒 轮状病毒 流行病学 临床特点 预后 

分 类 号：R72[医药卫生—儿科]