100例重症社区获得性肺炎住院儿童的病毒病原学分析

摘要

目的 了解重症社区获得性肺炎(CAP)儿童中常见呼吸道病毒的流行特征.方法收集2007年9月至2008年8月诊断为重症CAP的住院患儿鼻咽抽吸物标本100份,采用RT-PCR方法检测呼吸道合胞病毒(RSV)、鼻病毒(HRV)、流感病毒A(IFVA)、流感病毒B(IFVB)、副流感病毒1～3(PIV1～3)、偏肺病毒(hMPV)、冠状病毒NL63(HCoV-NL63)及冠状病毒HKU1(HCoV-HKU1),PCR方法检测腺病毒(ADV)、博卡病毒(HBoV),巢式PCR方法检测多瘤病毒WU(WUPyV)和多瘤病毒KI(KIPyV),并对阳性标本进行基因测序以证实.结果100份重症CAP住院患儿鼻咽抽吸物标本中病毒总检出例数为82例(82.0%),其中RSV检出率最高,为37.0%,其次为HBoV 25.0%和HRV 18.0%.病毒总检出率在男女之间差异无统计学意义;HBoV阳性检出率女性高于男性,差异有统计学意义(P<0.05),其他病毒检出率男女比较差异无统计学意义.阳性检出率在各年龄组之间差异有统计学意义(χ2=19.676,P<0.01),尤以0～6月龄组检出率最高.病毒总检出率在四季分布差异有统计学意义(χ2=9.729,P=0.021),以秋冬季检出率最高.有2种及以上病毒协同感染率为32.0%,RSV的协同感染率最高,依次是HBoV,HRV、PIV-3.结论病毒感染是重症CAP患儿的重要病因,其中RSV是最常见病毒病原,其次为HBoV和HRV;病毒检出率以0～6月龄组最高,秋冬季病毒总检出率高于其他季节;且病毒协同感染率较高.%Objective To learn viral etiology of severe community-acquired pneumonia among children. Methods One hundred nasopharyngeal aspirates specimens were collected from children with severe community-acquired pneumonia from September 2007 to August 2008. Respiratory syneytin virus (RSV), human rhinovirus (HRV). influenza virus A (IFVA), influenza virus B (IFVB), parainffuenzal-3 (P1V1-3), human metapneumovims (hMPV), human coronavimses NL63 (HCoV- NL63), human coronaviruses HKU1 (HCoV- HKU1) were detected by RT-PCR methods; Adenovirus (ADV) and human bocavirus (HBoV) were tested by standard PCR metliods; WU polyomavirases (WU1VV) and Kl polyomaviruses (KI1VV) were detected by nested-PCR methods. The amplicons were sequenced. Results In the 100 nasopharyngeal aspirate specimens, overall viruses detection rate was 82.0%. RSV was the most common virus with the detection rate of 37.0% while the rates of HBoV and HRV were 25 .0% and 18.0%, respectively. There was no significant difference of detection rale between male and female (X2=1.153, P=0.283). The HBoV detection rate in female was higher than that in male, but the difference was not significant between male and female in other viruses. There was significant difference in the age distribution of the virus detection rate (X2=19.676, P<0.001), especially in the age of 0~6 months old. There was remarkable seasonal distribution of the virus detection rate with the peak prevalence ofviruses in autumn and winter. More than one viruses were detected in 32 individual (32.0%) samples. RSV co-infection rate was the highest, followed by HBoV. HRV and PIV-3. Conclusions Viral pathogens are the main etiology of severe community-acquired pneumonia in young children in Changsha area during the study period. RSV is the most frequent viral pathogens followed by HBoV and HRV. The detection rate was highest in the age of 0-6 months old. The peak prevalence of viruses is in autumn and winter. And co-infection rate of viruses is high.