目的 了解上海市门诊腹泻婴幼儿中腺病毒(HAdV)的流行病学特征.方法 收集2012年1月1日至2016年12月31日每周三在复旦大学附属儿科医院(我院)门诊就诊、≤5岁、病程≤14d的急性腹泻患儿临床病毒检测后的剩余粪便标本,以系统抽样,采用PCR法检测HAdV、星状病毒、轮状病毒和诺如病毒,并通过基因测序和进化树分析确定HAdV的型别.结果 共1 010例样本进入本文分析,2012至2014年每年144例,2015年265例,2016年313例;男628例;0～6、～12、～ 24、～36、～48和～60月龄分别为246、578、79、45、18和44例.①5年HAdV总检出率为5.2％(53/1 010),2012至2016年依次为6.9％(10/144)、10.4％(15/144)、5.6％ (8/144)、4.5％(12/265)和2.6％(8/313),不同年份差异无统计学意义.②不同性别、不同月龄患儿和不同月份HAdV检出率差异均无统计学意义.③53例共检测到10种HAdV型别,肠道腺病毒(EAdV)包括HAdV 41型(31/53,58.5％)和40型(3.8％),非肠道腺病毒(NEAdV)包括HAdV 31型(11.3％)、1型(5.7％)、3型(5.7％)、2型(3.8％)、5型(3.8％)、6型(3.8％)、4型(1.9％)和7型(1.9％).各年份均以HAdV 41型为主.④HAdV单一感染占73.6％ (39/53),EAdV、NEAdV单一感染分别为49.1％ (26/53)和24.5％ (13/53);14例为HAdV和其他腹泻病毒混合感染,主要为HAdV与轮状病毒(13.2％,7/53)或诺如病毒(9.4％,5/53)的两两混合感染.结论 上海地区门诊腹泻婴幼儿中HAdV流行型别多样,常年散在流行,且主要为单独感染引发婴幼儿腹泻.%Objective To characterize the molecular epidemiology of human adenoviruses (HAdVs) and understand their association with acute diarrhea in outpatient children in Shanghai.Methods Fecal samples were collected from children under five years who were admitted to Children's Hospital of Fudan University as outpatients and diagnosed as acute diarrhea (Duration of diarrhea ≤ 14 days) from January 2012 to December 2016.All selected stool samples were subjected to reverse transcriptase PCR (RT-PCR) or PCR to detect group A rotavirus (RVA),human calicivirus (HuCV),human astrovirus (HAstV) and HAdV.Results A total of 1 010 fecal specimens were prospectively enrolled in this study with annual total of 144,144,144,265 and 313 samples collected respectively from 2012 to 2016.Among the enrolled patients,628 of them were boys and 382 were girls.Among them,246 individuals aged 0 to 6 months,578 individuals aged 7 to 12 months,79 individuals aged 13 to 24 months,45 individuals aged 25 to 36 months,18 individuals aged 37 to 48 months and 44 individuals aged 49 to 60 months.①HAdV infections were detected in 5.2％(53/1010) specimens and the detection rate was 6.9％(10/144),10.4％(15/144),5.6％ (8/144),4.5％ (12/265) and 2.6％ (8/313) respectively from 2012 to 2016.And they did not achieve statistical significance (x2=13.436,P=0.09).②There was no significant difference of HAdV detection rate among different gender groups,age groups and each month.③Of the 53 HAdV-positive samples,62.3％ (33/53) were classified as EAdV including HAdV 41 (31/53,58.5％) and-40 (3.8％,2/53) while the others were NEAdV including HAdV-31 (11.3％),-1 (5.7％),-3 (5.7％),-2(3.8％),-5 (3.8％),-6 (3.8％),-4 (1.9％) and-7 (1.9％).HAdV 41 was the most prevalent HAdV genotype in each year.④Among the HAdVs positive specimens,49.1％ (26/53) were EAdV mono-infections and 24.5％ (13/53) were NEAdV monoinfections while others were mixed infection with other diarrhea viruses.Among the mixed-infection cases,HAdVs mixed with RV (13.2％,7/53) or NoV (9.4％,5/53) were the most patterns.Conclusion These results clearly indicated the high diversity of the HAdVs genotypes detected in outpatient children with acute diarrhea and most of them were HAdV mono-infection cases.
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