河南省180例重症肺炎病例呼吸道病毒谱分析  

Respiratory virus spectrum in 180 severe pneumonia patients in Henan Province

作　　者：毋碧聪 宋云 卢世栋 聂轶飞[1] 叶莹[1] 黄学勇[1] 郭万申[1] 马红霞[1] WU Bicong;SONG Yun;LU Shidong;NIE Yifei;YE Ying;HUANG Xueyong;GUO Wanshen;MA Hongxia(Henan Key Laboratory of Infectious Disease Microbiology,Institute of Prevention and Control of Infectious Disease,Henan Center for Disease Control and Prevention,Zhengzhou,Henan 450016,China)

机构地区：[1]河南省疾病预防控制中心传染病预防控制所,河南省传染病病原生物重点实验室,河南郑州450016

出　　处：《现代疾病预防控制》2024年第7期509-513,共5页MODERN DISEASE CONTROL AND PREVENTION

基　　金：河南省医学科技攻关项目(232102310180);河南省医学科技攻关计划项目(LHGJ20220510);河南省医学科技攻关计划联合共建项目(LHGJ20230622);河南省医学科技攻关计划联合共建项目(LHGJ20230628)。

摘　　要：目的分析河南省重症肺炎病例常见呼吸道病毒谱构成及流行特征,研究甲型流感病毒的基因特征,为重症肺炎的病原学诊断和科学防控提供依据。方法对2019年9月—2020年2月河南省20家哨点医院的180份重症肺炎住院病例的呼吸道标本,采用多重PCR法检测新型冠状病毒(SARS-CoV-2)、甲型流感病毒(FluA)、乙型流感病毒(FluB)、鼻病毒(RhV)、冠状病毒NL63(CoV-NL63)、冠状病毒229E(CoV-229E)、冠状病毒OC43(CoV-OC43)、冠状病毒HKU1(CoV-HKU1)、副流感病毒1型(PIV1)、副流感病毒2型(PIV2)、副流感病毒3型(PIV3)、副流感病毒4型(PIV4)、人偏肺病毒(MPV)、博卡病毒(BoV)、呼吸道合胞病毒(RSV)、腺病毒(ADV)、肠道病毒(ENV),并对FluA阳性标本进行全基因组测序分析。结果180份重症肺炎病例的呼吸道标本中,病毒阳性总检出率为26.67%,病原检出前3位依次为FluA(10.00%)、RSV(3.89%)和RhV(3.89%),SARS-CoV-2阳性检出率为0.00%。病毒阳性检出率男性(31.90%)高于女性(17.19%)(χ^(2)=4.563,P<0.05),各年龄组间差异有统计学意义(χ^(2)=18.538,P<0.05),0~<7岁组的病毒阳性检出率最高,为76.92%,以RSV为主。获得5个FluA毒株的全基因组序列,经分析均为H3N2亚型,且与当年推荐疫苗株相比,血凝素(HA)基因出现抗原性位点改变,表明已出现抗原漂移。结论2019—2020年秋冬季河南省引起重症肺炎的呼吸道病毒主要是FluA、RSV和RhV,且以婴幼儿感染为主。FluA的基因型主要是H3N2亚型。Objective To analyze the common respiratory virus spectrum and epidemic characteristics in patients with severe pneumonia in Henan Province,and to study the genetic characteristics of influenza A virus,providing a basis for etiological diagnosis and scientific prevention and control of severe pneumonia.Methods Respiratory tract specimens from 180 patients with severe pneumonia,collected from 20 sentinel hospitals in Henan Province from September 2019 to February 2020,were retrospectively analyzed using multiplex PCR for to detect SARS-CoV-2,influenza A and B virus,rhinovirus,coronavirus,parainfluenza virus type 1,2,3,and 4,human metapneumovirus,boca virus,respiratory syncytial virus,adenovirus,and enterovirus.Influenza A positive specimens were further analyzed by whole genome sequencing.Results The positive detection rate of virus in patients with severe pneumonia was 26.67%,with influenza A(FluA,10.00%),respiratory syncytial virus(RSV,3.89%),and rhinovirus(RhV,3.89%)being the most prevalent.No cases of SARS-CoV-2 were detected.The virus positive rate was higher in males(31.90%)than in females(17.19%)(χ^(2)=4.563,P<0.05),and varied significantly across age groups(χ^(2)=18.538,P<0.05)with the highest virus positive rate in the 0-<7 years age group(76.92%),predominantly infected wit RSV.Whole genome sequences of 5 FluA strains revealed all to be H3N2 subtypes,antigenic site changes in the HA gene indicating antigenic drift.Conclusions FluA,RSV and RhV were the main respiratory viruses causing severe pneumonia in Henan Province during the autumn and winter of 2019-2020,with the majority of infections occurring in infants.The predominant influenza A subtype was H3N2.

关 键 词：重症肺炎 呼吸道病毒 甲型流感病毒 血凝素基因 抗原性 

分 类 号：R523.1[医药卫生—内科学]