儿童社区获得性肺炎中人鼻病毒感染的临床流行病学特征研究  

Study on the clinical epidemiological characteristics of human rhinovirus infection in children with community-acquired pneumonia

作　　者：艾军红 卢根 孙云 李昌崇[4] 靳蓉[5] 尚云晓[6] 徐保平[7] 谢正德 Ai Junhong;Lu Gen;Sun Yun;Li Changchong;Jin Rong;Shang Yunxiao;Xu Baoping;Xie Zhengde(Beijing Key Laboratory of Pediatric Respiratory Infection Diseases,Key Laboratory of Major Diseases in Children,Ministry of Education,National Clinical Research Center for Respiratory Diseases,Research Unit of Critical Infection in Children,Chinese Academy of Medical Sciences 2019RU016,Laboratory of Infection and Virology,Beijing Pediatric Research Institute,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Respiratory,Guangzhou Women and Children′s Medical Center,Guangzhou 510623,China;Department of General Pediatrics,Yinchuan Women and Children Healthcare Hospital,Yinchuan 750002,China;Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University,Wenzhou 325027,Zhejiang Province,China;Department of Respiratory,Guiyang Maternal and Child Health Hospital,Guiyang 550003,China;Department of Pediatric Respiratory,Shengjing Hospital of China Medical University,Shenyang 110004,China;National Clinical Research Center for Respiratory Diseases,Department of Respiratory Medicine,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院,北京市儿科研究所,感染与病毒研究室,儿科重大疾病研究教育部重点实验室,儿童呼吸道感染性疾病研究北京市重点实验室,中国医学科学院儿童危重症感染诊治创新单元,北京100045 [2]广州市妇女儿童医疗中心呼吸科,510623 [3]银川市妇女儿童保健院普儿科,750002 [4]温州医科大学附属第二医院/育英儿童医院呼吸科,浙江温州325027 [5]贵阳市妇幼保健院呼吸科,550003 [6]中国医科大学附属盛京医院小儿呼吸内科,沈阳110004 [7]国家儿童医学中心,首都医科大学附属北京儿童医院呼吸科,国家呼吸系统疾病临床医学研究中心,北京100045

出　　处：《中华实用儿科临床杂志》2021年第24期1866-1870,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家科技重大专项(2017ZX10103004-004)。

摘　　要：目的了解我国儿童社区获得性肺炎(CAP)中人鼻病毒(HRV)的优势基因型及流行特点。方法采集2017年6月至2019年12月我国南、北方地区(以秦岭-淮河为界)6家医疗机构的CAP住院患儿的咽拭子或鼻咽抽吸物,应用多重呼吸道病原体检测试剂盒,筛查16种常见呼吸道病毒。对HRV阳性样本进行基因分型,并行流行病学分析。结果本研究CAP患儿(2913例)中,HRV的总检出率为12.2%(356例),其中北方地区为10.3%(145/1410例),南方地区为14.0%(211/1503例)。南方地区HRV检出率显著高于北方地区,差异有统计学意义(χ^(2)=9.562,P=0.002)。流行病学分析显示,北方地区HRV阳性病例在各年龄段分布较平均,而南方地区90.5%的阳性病例为3岁以下婴幼儿。季节分布方面,北方地区HRV阳性病例主要分布在夏、秋季,而南方地区主要分布在春、秋季。HRV与其他病原的混合感染率为40.7%,南方地区混合感染率为49.0%,显著高于北方地区的28.0%,差异有统计学意义(χ^(2)=15.801,P<0.001)。北方地区HRV最常见的混合感染病原依次为呼吸道合胞病毒(RSV)、人博卡病毒(HBOV)和副流感病毒Ⅲ型(PIV3),混合感染率分别为5.0%、5.0%和4.0%。南方地区HRV最常见的混合感染病原依次为RSV、PIV3和人偏肺病毒(HMPV),混合感染率分别为9.0%、7.0%和6.0%。病毒基因分析结果显示,3种HRV基因型均有检出,HRV-A(118/220例)为优势基因型,其次为HRV-C(82/220例)。结论本研究儿童CAP中HRV的检出率为12.2%,南、北方地区HRV阳性病例在年龄及季节分布上存在差异。HRV与其他病原存在混合感染,南方地区混合感染率显著高于北方地区。HRV-A为优势基因型,其次为HRV-C。Objective To analyze the dominant genotypes and epidemic characteristics of human rhinovirus(HRV)in pediatric community-acquired pneumonia(CAP)in China.Methods Between June 2017 to December 2019,throat swabs or nasopharyngeal aspirates were collected from pediatric CAP patients hospitalized in 6 medical institutions in Southern and Northern China(bounded by Qinling and Huaihe River),respectively.A total of 16 species of common respiratory viruses were screened using respiratory pathogen detection kits.Samples with positive HRV were genotyped for further epidemiological analysis.Results The total detection rate of HRV in pediatric CAP(2913 cases)was 12.2%(356 cases)in this study,which was 10.3%(145/1410 cases)and 14.0%(211/1503 cases)in Northern and Southern China,respectively.The detection rate of HRV in the Southern region was significantly higher than that in the Northern region,the difference was statistically significant(χ^(2)=9.562,P=0.002).Epidemiological analysis showed that the distribution of HRV-positive cases in the Northern region was similar in all age groups,while 90.5%of positive cases in the Southern region were infants under 3 years.Classified by seasonal distribution,HRV-positive cases in the Northern region were mainly distributed in summer and autumn,while those in the Southern region were mainly distributed in spring and autumn.The coinfection rate of HRV and other pathogens was 40.7%,which was significantly higher in the Southern region than that of Northern region(49.0%vs.28.0%),the difference was statistically significant(χ^(2)=15.801,P<0.001).The most common pathogens mixed with HRV were respiratory syncytial virus(RSV),human boca virus(HBOV)and parainfluenza virus typeⅢ(PIV3)in the Northern region,with the mixed infection rate of 5.0%,5.0%and 4.0%,respectively,which were RSV,PIV3 and human metapneumovirus(HMPV)in the Southern region,with the mixed infection rate of 9.0%,7.0%and 6.0%,respectively.The genotyping results showed that all three HRV genotypes were detected.HRV-A(118/220 ca

关 键 词：人鼻病毒 流行病学 基因型 社区获得性肺炎 儿童 

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