苏州市2013年-2017年5岁以下住院儿童病毒性腹泻的病原学分析

摘要

目的 分析苏州市5 岁以下病毒性腹泻的常见病原及流行病学特点,以助于小儿病毒性腹泻的防治.方法 收集2013年1月—2017年12月在苏州大学附属儿童医院消化科住院的5 岁以下病毒性腹泻患儿粪便标本1 735 例,采用ELISA法检测A组轮状病毒(RV),阳性标本采用RT-PCR法进行毒株分型鉴定;诺如病毒(NoV)、扎如病毒(SaV)、肠道腺病毒(EAdV)、星状病毒(AstV)采用RT-PCR或PCR法进行检测.结果 共收集1 735 例标本,五种病毒检出率分别为A组RV 31.6%、NoV 16.9%、SaV 2.3%、EAdV 2.6%、AstV 1.9%,其中混合感染例数占9.0%.(1)A组RV的G血清学以G9为主83.6%,P基因分型以P[8]为主(94.5%),G血清型和P基因型组合以G9P[8]为主,549 例A组RV阳性标本中,以12～23月龄组检出率最高,检出率最高季节在10月到次年2月.(2)293 例NoV阳性标本中,以12～23月龄组和36～60月龄组检出率最高,检出率最高季节在10月.(3)40 例SaV阳性标本中12～60月龄组检出率高;45 例EAdV阳性标本中＜2 岁占73.3%;33 例AstV阳性标本中＜2 岁占81.8%.结论 A组RV是苏州市5 岁以下住院儿童病毒性腹泻的最主要病原,其次是NoV,A组RV的流行菌株为G9P[8],不同种类的病毒的流行病学特点不同.%Objective To analyze the common pathogens and prevalence characteristics of viral diarrhea of the children in hospital that under 5 years in Suzhou, in order to prevent and treat the children with viral diarrhea. Methods 1 735 fecal specimens were collected from the children under 5 years with viral diarrhea who were hospitalized in the digestive department of Children's Hospital Affiliated to Soochow University from January 2013 to December 2017, rotavirus (RV) was detected by ELISA, strain characterization was carried out by nested PCR, norovirus (NoV), spavirus (SaV), enteric adenoviruses (EAdV) and astrovirus (AstV) were detected by RT-PCR or PCR. Results A total of 1 735 fecal specimens were collected and tested. The positive rate of RV, NoV, SaV, EAdV and AstV was 31.6%, 16.9%, 2.3%, 2.6% and 1.9%. Co-infection with multiple enteric viruses were present in 9.0% of all samples. (1)RV G9 was the most serotype (83.6%), and P[8] (94.5%) was the most common genotype. The most common G-P combination was G9P[8]. Among the 549 RV positive specimens, the virus detection rate of 12～23 month age group was the highest, the peak of virus detection was concentrated in October to next February. (2)In 293 NoV positive specimens, the detection rate of 12～23 months and 36～60 months was the highest. The peak of virus detection was concentrated in October. (3)40 cases positive specimens of SaV, the virus detection rate of 12～60 month age group was high; 45 cases of EAdV positive specimens, of which ＜2 years old accounted for 73.3%, 33 cases of AstV positive specimens, of which ＜2 years old accounted for 81.8%. Conclusion Group A RV was the most important pathogen of viral diarrhea in children under 5 years in Suzhou, the second was NoV. The epidemic strains of group A RV was G9P[8], and the epidemiological characteristics of different kinds of viruses were different.