北京地区五岁以下儿童病毒性急性胃肠炎病原构成与临床特征分析  

Analysis of pathogenic composition and clinical characteristics of viral acute gastroenteritis in children under five years old in Beijing

作　　者：李洁[1] 杨扬[2] 梁志超[2] 高志勇[2] 贾蕾[2] 刘白薇[2] 陈丽娟[2] 王全意[2] Li Jie;Yang Yang;Liang Zhichao;Gao Zhiyong;Jia Lei;Liu Baiwei;Chen Lijuan;Wang Quanyi(Institute for HIV/AIDS and STD Prevention and Control,Beijing Center for Disease Prevention and Control,Research Center for Preventive Medicine of Beijing,Beijing 100013,China;Institute for Infectious Disease and Endemic Disease Control,Beijing Center for Disease Prevention and Control,Research Center for Preventive Medicine of Beijing,Beijing 100013,China)

机构地区：[1]北京市疾病预防控制中心性病艾滋病防治所北京市预防医学研究中心,100013 [2]北京市疾病预防控制中心传染病地方病控制所北京市预防医学研究中心,100013

出　　处：《中华预防医学杂志》2020年第10期1104-1110,共7页Chinese Journal of Preventive Medicine

摘　　要：目的:了解北京地区5岁以下儿童轮状病毒、诺如病毒、腺病毒及星状病毒相关急性胃肠炎的流行特点和临床特征。方法:在北京地区6个区县6家医院肠道门诊每月收集前30名年龄在5岁以下首次就诊的急性胃肠炎患者的信息资料和粪便样本,并对轮状病毒、诺如病毒、腺病毒及星状病毒四种病原进行PCR检测,采用描述性流行病学方法对四种病毒相关的急性胃肠炎流行特征进行描述,单因素方差分析各病毒引起的急性胃肠炎的Vesikari临床严重程度评分,采用非条件logistic回归分析急性胃肠炎的临床特征相关危险因素。结果:2 052份样本中,非混合感染709例(34.6%):其中轮状病毒411例(20.0%),诺如病毒153例(7.5%),腺病毒86例(4.2%),星状病毒59例(2.9%);混合感染135例(6.6%)。轮状病毒性急性胃肠炎的Vesikari评分(8.0±3.1)高于诺如病毒(6.4±2.4, P<0.001)、腺病毒(6.2±2.1, P<0.001)及星状病毒(6.1±2.0, P<0.001)。临床特征比较结果显示:以星状病毒为参照,5岁以下儿童感染轮状病毒急性胃肠炎后更易出现:≥5 d的腹泻( OR=3.33)、1 d内≥3次的呕吐( OR=8.79)、≥1 d的呕吐( OR=3.96)、Vesikari评分≥11的重症病例( OR=13.19);感染诺如病毒易出现1 d内≥3次的呕吐( OR=5.71);感染腺病毒易出现≥5 d的腹泻( OR=2.62);以轮状病毒为参照,5岁以下儿童感染诺如病毒( OR=0.40)或腺病毒( OR=0.28)后较少出现≥38.4 ℃的发热症状。 结论:本研究结果显示各病毒导致的急性胃肠炎特点不同,轮状病毒引起的急性胃肠炎临床症状较重,24月龄以下婴幼儿是轮状病毒感染的高危人群,应尽早采取有效预防措施如接种疫苗来保护易感人群。Objective To understand the epidemiological characteristics and clinical features of rotavirus-,norovirus-,adenovirus-and astrovirus-associ ated acute gastroenteritis in children under 5 years old in Beijing from Octorber,2015 to March,2017.Methods In the intestinal clinic of 6 hospitals in 6 districts of Beijing,information and stool samples of the first 30 patients with acute gastroenteritis who are under the age of 5 years are collected monthly.Rotavirus,norovirus,adenovirus and astrovirus are identified by PCR.Descriptive epidemiological method was used to describe the epidemiological characteristics of diarrhea caused by rotavirus,norovirus,adenovirus and astrovirus in Beijing.One-way analysis of variance was used to analyze the Vesikari clinical severity score of of acute gastroenteritis caused by each virus.Unconditional logistic regression analysis was used to analysis the associated factors of clinical features.Results Of the 2052 samples,709(34.6%)were non-mixed infections:the positive rate of rotavirus,norovirus,adenovirus and astrovirus were 20.0%,7.5%,4.2%and 2.9%,respectively.A total of 135 cases(6.6%)were mixed infection.The mean and standard deviation of Vesikari clinical severity score was 8.0±3.1 for rotavirus associated acute gastroenteritis,which was significantly higher than norovirus(6.4±2.4,P<0.001),adenovirus(6.2±2.1,P<0.001)and astrovirus(6.1±2.0,P<0.001).The comparison of clinical features showed that compared with astrovirus,the children under 5 years old infected with rotavirus were more likely to have a diarrhea≥5 days(OR=3.334),have vomiting≥3 times within one day(OR=8.788),have vomiting≥1 day(OR=3.963),have a Vesikari clinical severity score≥11 severe cases(OR=13.194).Norovirus infected cases were prone to have vomiting≥3 times in 1 day(OR=5.710).Adenovirus infected cases were prone to have a diarrhea≥5 days(OR=2.616).When using rotavirus as a reference,children under 5 years of age were less likely to develop fever≥38.4℃after infection with norovirus(OR=0.397)or

关 键 词：胃肠炎 轮状病毒 诺如病毒 人 腺病毒 星状病毒 

分 类 号：R725.1[医药卫生—儿科]