儿童呼吸道腺病毒感染488例临床特征和流行病学分析  

Clinical and epidemiological characteristics of respiratory adenovirus infections in children:analysis of 488 cases

作　　者：王彩云[1] 刘娟娟 米芋枚[1] 陈静[1] 毕静[2] 陈英虎[1] Wang Caiyun;Liu Juanjuan;Mi Yumei;Chen Jing;Bi Jing;Chen Yinghu(Department of Infectious Diseases,the Children’s Hospital of Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China;Department of Otolaryngology Head and Neck Surgery,the Children’s Hospital of Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院感染科国家儿童健康与疾病临床研究中心,杭州310052 [2]浙江大学医学院附属儿童医院耳鼻喉头颈外科国家儿童健康与疾病临床研究中心,杭州310052

出　　处：《中华临床感染病杂志》2021年第2期121-126,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：浙江省医药卫生科技计划项目(2018KY451)。

摘　　要：目的:研究住院儿童呼吸道人腺病毒(HAdV)感染的临床和流行病学特征,为临床及时合理诊治提供参考依据。方法:回顾性分析2018年9月至2019年8月于浙江大学医学院附属儿童医院住院治疗的488例呼吸道HAdV感染患儿临床资料。所有鼻(咽)拭子或鼻咽抽吸物(NPAs)通过直接免疫荧光法检测。非正态分布计量资料采用Kruskal Wallis H检验,以P<0.05为差异有统计学意义。计数资料采用χ^(2)检验或Fisher确切概率法,组间率的比较采用Bonfereoniχ^(2)分割,校正后以P<0.007为差异有统计学意义。结果:7072例急性呼吸道感染病例中检测出488例HAdV感染,检出率6.9%,其中男性305例(62.5%)、女性183例(37.5%)。488例HAdV阳性患儿中位发病年龄为43个月(39 d~12岁),6个月~<2岁组HAdV检出率(8.7%,123/1408)高于<6个月组(3.0%,6/197)和≥5岁组(4.6%,89/1948),差异均有统计学意义(χ^(2)=7.57,23.98,P均<0.007);2~<5岁组检出率(7.7%,270/3519)高于<6个月组和≥5岁组,差异均有统计学意义(χ^(2)=5.809,19.688,P均<0.007)。冬季检出人数达峰值12.9%(238/1840),与春、夏和秋季检出率(4.7%、3.9%和5.5%)相比差异均有统计学意义(χ^(2)=103.477,58.986和49.926,P均<0.007)。平均住院时间(6±4)d(1~41 d),486例(99.5%)治疗后好转出院,2例死亡。上呼吸道感染111例(22.7%),支气管炎34例(7.0%),肺炎343例(70.3%),其中重症肺炎86例(86/343,25.1%)。常见症状为发热(93.4%,456/488)、咳嗽(94.7%,462/488)、喘息(26.2%,128/488)和气促(14.8%,72/488)。138例(28.3%)出现肺外症状,78例(16.0%)伴有基础疾病,其中先天性心脏病所占比例(16例,3.3%)最高。456例出现发热症状的HAdV阳性患儿平均热程(8.8±2.4)d(5~17 d),其中热程>7~10 d 277例、>10 d 96例;高热(≥39℃)439例。275例(56.4%)为单一感染,213例(43.6%)为混合感染。混合感染组患儿发热、高热、热程>10 d、重症肺炎和喘息比例以及住院天数均高于单一感染组,差异均有统计学意义Objective To investigate the clinical and epidemiological features of acute respiratory adenovirus infection in children.Methods Clinical data of 488 children with acute respiratory tract human adenovirus(HAdV)infection admitted in Children’s Hospital of Zhejiang University School of Medicine from September 2018 to August 2019 were retrospectively analyzed.Nasopharyngeal swabs or nasopharyngeal aspirates(NPAs)were collected and tested by direct immunofluorescence assay.Kruskal Wallis H test was used for quantitative data without normal distribution,and P<0.05 was considered to be statistically significant.The qualitative data were compared by chi-square test or Fisher’s exact test.Bonfereoni chi-square segmentation was performed for comparison between groups,and P<0.007 was considered statistically significant after correction.Results A total of 488 HAdV positive cases were detected from 7072 patients with acute respiratory tract infection(6.9%),including 305 males(62.5%)and 183 females(37.5%).The median age of HAdV positive children was 43 months(39 days to 12 years).The detection rate in 6 m-<2 y age group(8.7%,123/1408)was significantly higher than those in<6 m group(3.0%,6/197)and≥5 y group(4.6%,89/1948)(χ^(2)=7.57,23.98,P all<0.007).The detection rate in 2-<5 y group(7.7%,270/3519)was significantly higher than those in<6 m group and≥5 y group(χ^(2)=5.809,19.688,P all<0.007).The peak rate was detected in the winter[12.9%(238/1840)]which was significantly higher than those in spring(4.7%),summer(3.9%),and autumn(5.5%)(χ^(2)=103.477,58.986 and 49.926,P<0.007).The average length of hospital stay was(6±4)d(1-41 d).486 cases(99.5%)were discharged from hospital after treatment,and 2 cases died.There were 111 cases(22.7%)of acute upper respiratory tract infection,34 cases(7.0%)of bronchitis and 343 cases(70.3%)of pneumonia;and severe pneumonia was diagnosed in 86 cases(25.1%,86/343).The common clinical manifestations were fever 93.4%(456/488),cough 94.7%(462/488),wheezing 26.2%(128/488)and shortness of b

关 键 词：腺病毒 呼吸道感染 急性 临床特征 流行特征 儿童 

分 类 号：R725.6[医药卫生—儿科] R181.3[医药卫生—临床医学]