2014-2017年石家庄地区住院儿童急性呼吸道感染病毒病原学分析

摘要

目的 了解石家庄地区住院儿童急性呼吸道感染(acute respiratory tract infection,ARTI)的病毒病原特点及流行特征.方法 收集2014年至2017年河北省儿童医院住院的临床诊断为ARTI的患儿共28 512例,采集每例患儿的鼻咽试子1份,采用免疫荧光法进行7种呼吸道病毒检测,包括呼吸道合胞病毒(respiratory sycytial virus,RSV)、副流感病毒(parainfluenza virus,PIV)l～3型、流感病毒A、B (influenza virus type A,FluA;influenza virus type B,FluB)及腺病毒(adenovirus,ADV).结果 共9 263例检出至少1种病毒,总检出率为32.5％,其中,单一病毒感染9 070例,占97.9％,以RSV检出率最高,其次为PIV-3、FluA.RSV及PIV-3检出率4年中呈现逐年下降趋势;FluA近2年检出率升高;ADV、PIV-1检出率呈现隔年升高现象,差异均有统计学意义(P＜0.05).总检出率随年龄增加逐渐下降(趋势x2值=1191.289,P＜0.001).RSV、PIV-3以婴幼儿检出率最高,随年龄增加,检出率逐渐下降,FluA、FluB及ADV以学龄前儿童检出率最高,差异均有统计学意义(P＜0.05).冬季检出率最高,夏季检出率最低,差异有统计学意义(P＜0.05).RSV、FluA感染高峰是冬季,FluB感染高峰是冬春季;PIV-1感染高峰是夏季,PIV-2感染高峰是秋季,PIV-3感染高峰是春夏季,ADV呈全年散发.结论 2014年至2017年住院儿童ARTI中呼吸道病毒以RSV最为多见,但近4年呈现逐年下降趋势,而FluA感染近2年有所升高;婴儿期呼吸道病毒检出率最高,冬季为呼吸道病毒感染高发季节.%Objective To investigate the epidemiologic features of respiratory viral etiology in hospitalized children with acute respiratory tract infection (ARTI) in Shijiazhuang.Methods A total of 28 512 cases of hospitalized children with clinical diagnosis of ARTI in Children's Hospital of Hebei Province from 2014 to 2017 were recruited into this study.One nasopharyngeal swab was collected from each patient.Immunofluorescence assay was used to detect seven kinds of respiratory viruses,including respiratory syncytial virus (RSV),parainfluenza virus (PIV) type 1-3,influenza virus type A,B (FluA,FluB) and adenovirus (ADV).Results At least one viral pathogen was identified in each of 9 263 out of 28 512 patients and the overall positive rate was 32.5％.Of 9 263 virus-positive patients,9 070 (97.9％) had mono-infection.The most frequently detected virus was RSV,followed by PIV-3 and FluA.The positive rates of RSV and PIV-1 showed annually decreasing tendency,meanwhile the positive rate of FluA increased in the nearly two years.The detection rate of ADV and PIV-1 increased every other year.There was a significant difference in the positive rate among different years (P＜0.05).The overall positive rate decreased along with the age increased (linear by linear association x2 =1191.289,P＜ 0.05).The detection rates of RSV and PIV-3 were the highest in groups of ＜ 1 year old and 1-3 years old and decreased along with the age increased.The preschool children were more susceptible to developing FluA,FluB and ADV related diseases.There was a significant difference in the positive rate among different age groups (P＜0.05).The viral distribution was uneven in different seasons,and the infection peaked in winter,the difference was statistically significant (P＜0.05).The epidemic seasons of RSV and FluA were winter,and FluB infection was epidemic in winter and spring.The positive rates of PIV-1 and PIV-2 were most common in summer and autumn.PIV-3 was usually prevalent in spring and summer and ADV was prevalent sporadically.Conclusions RSV is the most common pathogen in hospitalized children with clinical diagnosis of ARTI during 2014-2017 and the positive rate of which showed an annually decreasing tendency.The positive rate of FluA increased in the nearly two years.Children in infancy are susceptible to the seven common respiratory viruses and winter is the epidemic season for these viruses.