新型冠状病毒肺炎疫情期间北京定点排查医院儿童急性呼吸道感染的病原谱观察  

Investigation of pathogenic agents causing acute respiratory tract infections in pediatric patients in a children′s hospital assigned for case screening in Beijing during the outbreak of COVID-19

作　　者：赵林清[1] 邓莉[2] 曹玲[3] 陈冬梅[1] 孙宇[1] 朱汝南[1] 王芳[1] 郭琪 周禹彤 贾立平[1] 黄辉[2] 康小会[3] 金凤华[2] 袁艺[3] 张楠[2] 德日 钱渊[1] Zhao Linqing;Deng Li;Cao Ling;Chen Dongmei;Sun Yu;Zhu Runan;Wang Fang;Guo Qi;Zhou Yutong;Jia Liping;Huang Hui;Kang Xiaohui;Jin Fenghua;Yuan Yi;Zhang Nan;De Ri;Qian Yuan(Laboratory of Virology,Beijing Key Laboratory of Etiology of Viral Diseases in Children,Capital Institute of Pediatrics,Beijing 100020,China;Department of Infectious Diseases,Affiliated Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China;Department of Respiratory Diseases,Affiliated Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所病毒研究室,儿童病毒病病原学北京市重点实验室,北京100020 [2]首都儿科研究所附属儿童医院感染科,北京100020 [3]首都儿科研究所附属儿童医院呼吸科,北京100020

出　　处：《中华儿科杂志》2020年第8期635-639,共5页Chinese Journal of Pediatrics

基　　金：北京市医院管理中心儿科学科协同发展中心专项(XTZD20180505)。

摘　　要：目的探讨新型冠状病毒肺炎(COVID-19)疫情期间北京地区儿童中急性呼吸道感染(ARI)的病原谱。方法采用前瞻性研究,自2020年1月20日至2月20日首都儿科研究所附属儿童医院入组3类患儿:有2019新型冠状病毒(2019-nCoV)相关流行病学史的ARI组(疑似病例组),无2019-nCoV相关流行病学史的ARI组(单纯ARI组),既无流行病学史也无呼吸道感染、但因其他疾病需住院治疗的排查组(非ARI组),每组预计纳入至少30例。疑似病例组同时采集咽拭子和鼻咽拭子标本,单纯ARI组及非ARI组仅采集鼻咽拭子标本;所有标本同步应用两个不同厂家的试剂盒进行2019-nCOV核酸检测;鼻咽拭子标本进行ARI多病原核酸检测。单纯ARI组与2019、2018年同期的ARI患儿多病原核酸检测结果比较采用t检验或χ2检验。结果至2020年2月20日总计入组244例患儿,男139例、女105例,年龄(5±4)岁,2019-nCoV核酸检测结果均为阴性。疑似病例组(69.4%,25/36)与单纯ARI组(55.3%,73/132)均有较高的病原检出,以肺炎支原体阳性检出率为最高[19.4%(7/36)、17.4%(23/132)];其次是人偏肺病毒[16.7%(6/36)、9.8%(13/132)];非ARI组病原检出率较低(11.8%,9/76)。2019年同期ARI患儿病原阳性检出率为83.7%(77/92),以呼吸道合胞病毒A(29.3%,27/92)为最高,然后依次为流感病毒H1N1(19.6%,18/92)及腺病毒(14.1%,13/92),与2020年单纯ARI组的3种病毒阳性检出率(分别为7/132,5.3%;0;5/132,3.8%)比较差异均有统计学意义(χ2=27.346、28.083、7.848,P均<0.01);2018年同期ARI患儿病原阳性检出率为61.0%(50/82),以人博卡病毒(13.4%,11/82)及腺病毒(11.0%,9/82)多见,与2020年单纯ARI组人博卡病毒阳性检出率(5/132,3.8%)比较,差异有统计学意义(χ2=6.776,P=0.009)。结论在非高风险地区,即使在有相关的流行病学史前提下,非家庭聚集性发病或非密切接触的儿童感染2019-nCoV的可能性仍很小;与既往同期患儿ARI的病原以病毒为主不同,COVID-19疫�Objective To investigate the spectrum of pathogenic agents in pediatric patients with acute respiratory infections(ARI)during the outbreak of coronavirus infectious diseases 2019(COVID-19).Methods Three groups of children were enrolled into the prospective study during January 20 to February 20,2020 from Capital Institute of Pediatrics,including children in the exposed group with ARI and epidemiological history associated with COVID-19 from whom both pharyngeal and nasopharyngeal swabs were collected,children in the ARI group without COVID-19 associated epidemiological history and children in the screening group for hospital admission,with neither COVID-19 associated epidemiological history nor ARI.Only nasopharyngeal swabs were collected in the ARI group and screening group.Each group is expected to include at least 30 cases.All specimens were tested for 2019-nCoV nucleic acid by two diagnostic kits from different manufacturers.All nasopharyngeal swabs were tested for multiple respiratory pathogens,whilst the results from the ARI group were compared with that in the correspondence periods of 2019 and 2018 used by t orχ2 test.Results A total of 244 children were enrolled into three groups,including 139 males and 105 females,the age was(5±4)years.The test of 2019-nCoV nucleic acid were negative in all children,and high positive rates of pathogens were detected in exposed(69.4%,25/36)and ARI(55.3%,73/132)groups,with the highest positive rate for mycoplasma pneumoniae(MP)(19.4%,7/36 and 17.4%,23/132,respectively),followed by human metapneumovirus(hMPV)(16.7%,6/36 and 9.8%,13/132,respectively).The positive rate(11.8%,9/76)of pathogens in the screening group was low.In the same period of 2019,the positive rate of pathogens was 83.7%(77/92),with the highest rates for respiratory syncytial virus(RSV)A(29.3%,27/92),followed by influenza virus(Flu)A(H1N1)(19.6%,18/92)and adenovirus(ADV)(14.1%,13/92),which showed significant difference with the positive rates of the three viruses in 2020(RSV A:χ2=27.346,P<0.01;FluA(H1N1

关 键 词：呼吸道感染 病原 儿童 新型冠状病毒肺炎 

分 类 号：R725.6[医药卫生—儿科] R446.5[医药卫生—临床医学]