青海地区急性呼吸道感染症候群中人冠状病毒及鼻病毒分子流行病学研究

摘要

目的 了解青海地区急性呼吸道感染人群中人冠状病毒(human coronavirus,HCoV)及鼻病毒(human rhinovirus,HRV)的分布,探讨其分子流行病学特征.方法 采集2010年5月至2015年5月青海地区急性呼吸道症候群病例鼻咽拭子445例,采用荧光定量反转录聚合酶链式反应(quantitative real-time reverse transcription polymerase chain reaction,qRT-PCR)方法对HCoV 6种亚型(OC43,HKU1,229E,NL63,SARS和MERS)及HRV进行检测,并分析其分子流行病学特点.结果 445例样本中共检出HCoV 34例,检出率7.64％,其中HCoV-OC43 19例(4.26％)、HCoV-HKU1 15例(3.37％),其他亚型未检出.HRV检出16例,检出率3.59％.HCoV-OC43在20-60岁年龄组检出率最高,为9.48％,且不同年龄组差异有统计学意义(Fisher's确切概率P =0.0011).HRV在门急诊病例中的检出率比住院病例高,为6.72％,且差异有统计学意义(Fisher's确切概率P =0.0432).HCoV-OC43与HCoV-HKU1夏季检出率最高,分别为为7.20％ (9/125)、9.60％(12/125);不同季节HCoV检出率差异有统计学意义(x2=25.08,P＜0.0001).HRV春季检出率最高,为10.17％ (6/59),不同季节检出率差异有统计学意义(Fisher's确切概率P=0.0449).HCoV感染阳性样本Ct值中位数36.81(35.54-37.49),在住院病例中为36.93(35.54-37.53),在门急诊病例中为36.68(31.18-36.84),差异无统计学意义.HRV阳性样本Ct值中位数31.83 (27.16-33.65),在住院病例中为28.97(26.39-33.79),在门急诊病例中为32.34(30.85-33.65),差异无统计学意义.结论 HCoV及HRV流行高峰主要为夏季和春季,其中HCoV-OC43/HCoV-HKU1是HCoV感染的主要亚型.Ct值在一定程度上反映了HCoV和HRV在不同病例类型中病毒载量的差异.%Objective To investigate the prevalence and molecular epidemiological characteristics of human coronavirus (HCoV) and human rhinovirus(HRV) among patients with acute respiratory syndrome in Qinghai area.Methods Total of 445 nasopharyngeal swabs were collected from acute respiratory syndrome group cases in Qinghai during May of 2010 and 2015,six subtypes (HCoV-OC43,-HKU1,-229E,-NL63,SARS-CoV and MERS-CoV)of HCoVs and HRV were detected by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) and related data analyzed.Results Thirty four cases of HCoV were detected form 445 cases (7.64％),of which HCoV-OC43 was 19 (4.26％),HCoV-HKU1 15 (3.37％),and the other subtypes were not detected.HRV was detected in 16 cases(3.59％) in 445 cases.The HCoV-OC43 positive rate existed statistically significant differences (Fisher's exact probability P =0.0011)among different age groups,with a high rate of 9.48％ among patients aged 20-50 years.The detection rate of HRV(2.45％,6.72％) in inpatient cases was lower than that of in outpatient and emergency cases (Fisher's exact probability P =0.0432).There were significant differences in detection frequencies of HCoV among seasons (x2 =25.08,P ＜ 0.0001),with HCoV-OC43 predominant in summer(7.20％) and HCoV-HKU1 dominating in summer(9.60％).The detection rate of HRV was also significant differences among seasons (Fisher's exact probability P =0.0449),with mainly detected in spring (10.17％).The median of Ct value of sample with HCoV infection and HRV infection was 36.81 (35.54-37.49),31.83 (27.16-33.65),respectively.There was no significant differences of Ct value between inpatient cases and outpatient and emergency cases of HCoV infection and HRV infection.Conclusions The seasonal distribution characteristic of HCoV and HRV infections can be found,which HCoV peak in summer and HRV dominate in spring.HCoV-OC43/HKU1 were main epidemic subtypes of HCoV.The Ct value reveals the divergence of viral load of HCoV and HRV in different case type to some extent.