北京地区急性呼吸道感染住院患儿腺病毒感染临床特征  

Clinical characteristics of human adenovirus infection in hospitalized children with acute respiratory infection in Beijing

作　　者：王方明 杨传宇 钱渊[1] 李芳 古丽 陈冬梅[1] 孙宇[1] 朱汝南[1] 王芳[1] 郭琪 周禹彤 德日 曹玲[3] 曲东[2] 赵林清[1] Wang Fangming;Yang Chuanyu;Qian Yuan;Li Fang;Gu Li;Chen Dongmei;Sun Yu;Zhu Runan;Wang Fang;Guo Qi;Zhou Yutong;De Ri;Cao Ling;Qu Dong;Zhao Linqing(Laboratory of Virology,Beijing Key Laboratory of Etiology of Viral Diseases in Children,Capital Institute of Pediatrics,Beijing 100020,China;Department of ICU,Children′s Hospital,Capital Institute of Pediatrics,Beijing 100020,China;Department of Respiratory Medicine,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重症医学科,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》2022年第1期30-35,共6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);北京市卫健委财政项目(2060399 PXM2017_026268_00005_00254486)。

摘　　要：目的比较北京地区急性呼吸道感染住院患儿中不同型别腺病毒感染临床特征,明确腺病毒分型的临床必要性。方法采用横断面研究,纳入2017年11月至2019年10月在首都儿科研究所附属儿童医院因急性呼吸道感染住院的9022例次患儿呼吸道标本,经直接免疫荧光(DFA)和(或)核酸检测确定为腺病毒阳性者进行五邻体、六邻体及纤维蛋白基因扩增并测序,构建系统进化树区分腺病毒型别。收集并分析腺病毒主要型别感染患儿的实验室检查、影像学资料等临床资料,采用t检验、U检验、χ^(2)检验进行型别间临床特征差异的统计学分析。结果9022例次急性呼吸道感染住院患儿中腺病毒阳性检出率为4.34%(392例次),成功分型205例,其中男131例、女74例,年龄22.6(6.7,52.5)月龄,3型腺病毒阳性102例(49.76%),7型86例(41.95%),1、2、4、6、14、21型共17例。7型与3型腺病毒感染患儿临床特征比较,在出现喘息[10例(11.63%)比25例(24.51%)]、白细胞计数>15×10^(9)/L[4例(4.65%)比14例(13.73%)]、白细胞计数<5×10^(9)/L[26例(30.23%)比11例(10.78%)]、降钙素原水平>0.5 mg/L[43例(50.00%)比29例(28.43%)]、多肺叶浸润[45例(52.33%)比38例(37.25%)]、胸腔积液[23例(26.74%)比10例(9.80%)]、危重症腺病毒肺炎[7例(8.14%)比2例(1.96%)]比例方面,差异均有统计学意义(χ^(2)=5.11、4.44、11.16、9.19、4.30、9.25、3.91,P=0.024、0.035、0.001、0.002、0.038、0.002、0.048);住院时间差异也有统计学意义[11(8,15)比7(5,13)d,Z=3.73,P<0.001]。结论北京地区急性呼吸道感染住院患儿中腺病毒感染以3、7型为主要型别。与3型感染比较,7型感染炎症反应更明显,肺部症状更重,住院时间更长,区分腺病毒型别具有临床必要性。Objective To compare the clinical characteristics of different types of human adenovirus(HAdV)infection in hospitalized children with acute respiratory infection in Beijing,and to clarify the clinical necessity of adenovirus typing.Methods In a cross-sectional study,9022 respiratory tract specimens collected from hospitalized children with acute respiratory infection from November 2017 to October 2019 in Affiliated Children′s Hospital,Capital Institute of Pediatrics were screened for HAdV by direct immunofluorescence(DFA)and(or)nucleic acid detection.Then the Penton base,Hexon and Fiber gene of HAdV were amplified from HAdV positive specimens to confirm their HAdV types by phylogenetic tree construction.Clinical data such as laboratory results and imaging data were analyzed for children with predominate type HAdV infection using t,U,orχ^(²)test.Results There were 392 cases(4.34%)positive for HAdV among 9022 specimens from hospitalized children with acute respiratory infection.Among those 205 cases who were successfully typed,131 were male and 74 were female,age of 22.6(6.7,52.5)months,102 cases(49.76%)were positive for HAdV-3 and 86 cases(41.95%),HAdV-7,respectively,while 17 cases were confirmed as HAdV-1,2,4,6,14 or 21.In comparison of clinical characteristics between the predominate HAdV type 7 and 3 infection,significant differences were shown in proportions of children with wheezing(10 cases(11.63%)vs.25 cases(24.51%)),white blood cell count>15×10^(9)/L(4 cases(4.65%)vs.14 cases(13.73%)),white blood cell count<5×10^(9)/L(26 cases(30.23%)vs.11 cases(10.78%)),procalcitonin level>0.5 mg/L(43 cases(50.00%)vs.29 cases(28.43%)),multilobar infiltration(45 cases(52.33%)vs.38 cases(37.25%)),pleural effusion(23 cases(26.74%)vs.10 cases(9.80%)),and severe adenovirus pneumonia(7 cases(8.14%)vs.2 cases(1.96%))withχ^(²)=5.11,4.44,11.16,9.19,4.30,9.25,3.91 and P=0.024,0.035,0.001,0.002,0.038,0.002,0.048,respectively,and also in length of hospital stay(11(8,15)vs.7(5,13)d,Z=3.73,P<0.001).Conclusions HAdV-3 and 7 were

关 键 词：儿童 呼吸道感染 人腺病毒 基因型 

分 类 号：R725.6[医药卫生—儿科]