2019—2020年上海市住院儿童病例发热呼吸道症候群病原谱研究  

Pathogen spectrum of febrile respiratory syndrome among hospitalized children in Shanghai from 2019 to 2020

作　　者：王春 赵雪 滕峥[2] 秦惠宏 顾浩翔 张泓[1] 张曦[2] Wang Chun;Zhao Xue;Teng Zheng;Qin Huihong;Gu Haoxiang;Zhang Hong;Zhang Xi(Department of Clinical Laboratory,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200040,China;Virus Testing Laboratory,Pathogen Testing Center,Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200336,China)

机构地区：[1]上海市儿童医院上海交通大学医学院附属儿童医院检验科,200040 [2]上海市疾病预防控制中心病原生物检定所病毒检测实验室,200336

出　　处：《中华实验和临床病毒学杂志》2022年第3期270-275,共6页Chinese Journal of Experimental and Clinical Virology

基　　金：传染病防治科技重大专项(2017ZX10103009-003);上海市公共卫生体系建设三年行动计划(2020-2022年)(GWV-10.1-XK03);上海市重点临床专科建设项目-即时监测(shslczdzk06902)。

摘　　要：目的了解上海市儿童住院病例中呼吸道症候群的病原谱及临床特征,为疾病的预防及临床诊断提供参考。方法利用荧光定量PCR结合熔解曲线的判定方法对634份下呼吸道吸取物标本进行22种病原体检测,采用卡方检验对不同检出率进行统计分析。结果在634份住院病例标本中,555份病原体核酸检测阳性,总阳性率为87.54%,检出的病原体主要为肺炎支原体(mycoplasma pneumonia,MP)、腺病毒(adenovirus,ADV)、呼吸道合胞病毒(respiratory syncytial virus,RSV)、甲型流感病毒(influenza virus A,FluA)及博卡病毒(bocavirus,BoV);多重感染的比率大于单一感染,多重感染的病原体类型是ADV、RSV、FluA或者BoV伴MP共感染;在年龄分布中,FluA在"<2岁"和"2~5岁"这两个年龄组检出率较高,RSV在"<2岁"年龄组的检出率明显高于其他两个年龄组,而冠状病毒在"2~5岁"和">5岁"的检出率要高于"<2岁"年龄组;结合临床症状的分析显示,RSV在非发热患者中的检出率高于发热患者的检出率,RSV及PIV在咳嗽患者的检出率高于非咳嗽患者的检出率,RSV在喘息患者中的检出率高于非喘息患者,RSV及FluA中的H3N2引起肺炎的概率较大;FLuA、FluB及RSV具有明显的冬春季流行高峰。结论应加强对MP、ADV、RSV、FluA及BoV等呼吸道病原体的持续性监测,了解其流行特征及致病力的变化,为儿童中呼吸道疾病的防控提供科学依据。Objective To understand the pathogenic spectrum and clinical characteristics of respiratory syndrome among hospitalized children in Shanghai,to provide reference for disease prevention and clinical diagnosis.Methods Twenty-two pathogens were detected in 634 lower respiratory tract aspirates by using fluorescence quantitative PCR combined with the determination method of dissolution curve,and chi-square test was used for statistical analysis of different detection rates.Results Among the 634 inpatient specimens,555 were positive for pathogen nucleic acid,with a total positive rate of 87.54%.The detected pathogens were mainly Mycoplasma pneumoniae(MP),adenovirus(ADV),respiratory syncytial virus(RSV),influenza A virus(FluA)and Boca virus(BoV),and the ratio of multiple pathogen infection was greater than single pathogen infection,the pathogen type of multiple infection was ADV,RSV,FluA or BoV co-infection with MP;in the age distribution,FluA has a higher detection rate in the"<2 year old"and"2-5 years old"age groups,and RSV had a significantly higher detection rate in the"<2 year old"age group compared with the other two age groups,the detection rate of coronavirus(CoV)in"2-5 years old"and">5 years old"is higher than that in"<2 year old"age group;combined with the analysis of clinical symptoms,RSV was found in non-febrile patients.The detection rate of RSV and PIV in cough patients was higher than that in non-cough patients,and the detection rate of RSV in wheezing patients was higher than that in non-wheezing patients.H3N2 in RSV and FluA had a high probability of causing pneumonia;FLuA,FluB and RSV had obvious epidemic peaks in winter and spring.Conclusions We should strengthen the continuous monitoring of respiratory pathogens such as MP,ADV,RSV,FluA and BoV for the purpose of better understanding the changes in their epidemiological characteristics and pathogenicity,and provide the scientific data for the prevention and control of respiratory diseases in children.

关 键 词：呼吸道感染 呼吸道合胞病毒 肺炎支原体 混合感染 

分 类 号：R725.6[医药卫生—儿科]