苏州地区儿童急性下呼吸道人鼻病毒感染的流行病学及喘息相关因素

摘要

目的 分析苏州地区儿童急性下呼吸道人鼻病毒(HRV)感染的流行病学特点及其引起喘息的相关危险因素.方法 回顾性分析2013年1月1日至2014年12月31日于苏州大学附属儿童医院住院的2 942例急性下呼吸道感染(ALRTI)患儿的临床资料,探讨HRV的感染情况、人群分布和时间分布特点,并采用Logistic多元回归分析HRV感染导致喘息的危险因素.结果 2 942例患儿中HRV阳性356例,阳性率12.10％;男女检出率差异无统计学意义[12.45％(233/1 872例)比11.50％(123/1 070例),x2=0.579,P=0.447];6个月～1岁婴儿检出率最高,为13.32％(65/488例),92.00％感染患儿为＜5岁儿童;HRV全年散发,夏秋季为高峰,检出率分别为12.93％(91/704例)和14.74％(93/631例),冬季8.97％(66/736例),冬季检出率显著低于其他季节,差异有统计学意义(x2=11.376,P＜0.05).喘息组患儿HRV检出率高于非喘息组,差异有统计学意义[13.55％(174/1 284例)比10.98％(182/1 658例)x22=4.509,P=0.034].Logistw多因素分析显示:性别、过敏史、既往反复呼吸道感染史及母孕期疾病史是HRV感染患儿发生喘息的独立危险因素(OR=0.391,95％ CI:0.240～0.636,P=0.000;OR=2.524,95％ CI:1.432～4.447,P=0.001;OR=1.980,95％ CI:1.225 ～3.199,P=0.005;OR=0.186,95％CI:0.050 ～0.695,P=0.012).结论 HRV是苏州地区儿童ALRTI的重要病原;5岁以下儿童易感,夏秋季为高峰.HRV感染患儿喘息发生率高,对于有个人过敏史、既往有反复呼吸道感染及母孕期有妊振高血压综合征等疾病史的患儿,尤其是男童,在HRV感染后更容易发生喘息,甚至发展为支气管哮喘.%Objective To analyze the epidemiological characteristics and the risk factors for wheezing in children with acute lower respiratory tract infections with human rhinovirus (HRV).Methods The clinical data of 2 942 patients with acute lower respiratory tract HRV infections in Children's Hospital of Soochow University were retrospec tively analyzed from January 1 st,2013 to December 31 st,2014.The HRV infection, characteristics of population distribution and temporal distribution were analyzed.Risk factors for wheezing were analyzed by Logistic regression.Results Of the 2 942 children, HRV was positive in 356 children, the positive rate was 12.10％.No significant diffe-rence was found in the detection rate between boys and girls[12.45％ (233/1 872 cases) vs 11.50％ (123/1 070 cases), x2 =0.579,P =0.447].The detection rate of children of 6-12 months-old was the highest [13.32％ (65/488 cases)].Ninety-two percent of the infected children were less than 5 years old.HRV was distributed with a peak in summer and autumn, and the detection rate was 12.93 ％ (91/704 cases) and 14.74％ (93/631 cases), respectively, while in winter it was 8.98％ (66/736 cases) ,and the detection rate in winter was significantly lower than that in other seasons(x2 =11.376 ,P ＜ 0.05).The detection rate of HRV was different between wheezing and non-wheezing group, and there was significant difference[13.55％ (174/1 284 cases) vs 10.98％ (182/1 658 cases) ,x2 =4.509,P =0.034].Logistic regression analysis showed that gender, allergies, history of recurrent respiratory tract infections and mother illness during pregnancy were independent risk factors for wheezing in HRV infected children(OR =0.391,95％ CI:0.240-0.636,P =0.000;OR =2.524,95％ CI:1.432-4.447,P =0.001;OR =1.980,95％ CI:1.225-3.199,P =0.005;OR =0.186,95％ CI:0.050-0.695 ,P =0.012).Conclusions HRV is an important pathogen for children's acute lower respiratory infection in Suzhou.Children less than 5 years old are susceptible to HRV infection,with a peak in summer and autumn.Children,who have a history of allergies, and a history of recurrent respiratory tract infections or mother illness during pregnancy,especially for boys ,are more prone to have wheezing,and may develop asthma.