2013~2018年重庆地区2 066例急性下呼吸道感染住院患儿呼吸道合胞病毒流行特征分析

doi:10.7499/j.issn.1008-8830.2007139

摘要
图/表
参考文献(30)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (1657 KB) HTML()
输出: BibTeX | EndNote (RIS) 背景资料

摘要

目的研究急性下呼吸道感染住院患儿呼吸道合胞病毒（RSV）检出率、流行规律及临床特征。方法收集2013年6月至2018年5月于重庆医科大学附属儿童医院呼吸中心住院的2岁以下急性下呼吸道感染（ALRI）患儿鼻咽抽吸物，采用多重PCR检测16种常见呼吸道病毒，分析RSV流行特征。结果共纳入2 066例ALRI住院患儿，病毒检出阳性1 595份（77.20%）。其中RSV阳性检出826份（39.98%）。RSV阳性样本中，RSV-A阳性410份（49.6%），RSV-B阳性414份（50.1%），RSV-A与RSV-B均阳性2份（0.2%）。2013~2014年、2016~2017年主导流行亚型为RSV-B，2014~2015年、2017~2018年以RSV-A为主要检出亚型，2015~2016年为RSV-A与RSV-B共同流行。冬季检出率最高。RSV合并人鼻病毒为最常见的2种病毒混合检出组合（123份）。该组患儿较单一RSV检出患儿更易出现喘息（P=0.030）。在2 066例患儿中，单一RSV检出298份，RSV混合其他病毒检出148份，其他病毒检出389份，病毒检出阴性241份。RSV单一检出组较其他病毒检出组和病毒检出阴性组月龄更小，更易发生呼吸困难、呼吸衰竭及重症下呼吸道感染（P < 0.0083）。RSV-A阳性患儿中的男性比例高于RSV-B阳性患儿（P=0.004），而临床表现二者未见显著差异。结论 2013~2018年重庆地区RSV-A与RSV-B既可分别主导流行，也可共同流行；RSV为急性下呼吸道感染住院患儿最主要病毒病原，易导致重症下呼吸道感染；RSV-A和RSV-B感染患儿临床表现无差异，但RSV-A更易感染男性患儿。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	任康轶
	任洛
	邓昱
	谢晓虹
	臧娜
	谢军
	罗征秀
	罗健
	符州
	刘恩梅
	李渠北

关键词 ：呼吸道感染, 呼吸道合胞病毒, 流行特征, 儿童

Abstract：Objective To study the detection rate, epidemic pattern, and clinical features of respiratory syncytial virus (RSV) in hospitalized children with acute lower respiratory infection (ALRI). Methods Nasopharyngeal aspirates were collected from children with ALRI, aged < 2 years, who were hospitalized in Children's Hospital of Chongqing Medical University from June 2013 to May 2018. Multiplex PCR was used to detect 16 common respiratory viruses. The epidemiological characteristics of RSV were analyzed. Results A total of 2 066 hospitalized children with ALRI were enrolled. Among the children, 1 595 (77.20%) tested positive for virus and 826 (39.98%) tested positive for RSV [410(49.6%) positive for RSV-A, 414 (50.1%) positive for RSV-B, and 2 (0.2%) positive for both RSV-A and RSV-B]. RSV-B was the main subtype detected in 2013-2014 and 2016-2017, while RSV-A was the main subtype in 2014-2015 and 2017-2018, and these two subtypes were prevalent in 2015-2016. The highest detection rate of RSV was noted in winter. RSV + human rhinovirus was the most common combination of viruses and was detected in 123 children. These children were more likely to develop wheezing than those with single RSV detected (P=0.030). A total of 298 samples were detected with single RSV, 148 were detected with RSV mixed with other viruses, 389 were detected with other viruses, and 241 were detected negative for viruses. Compared with the other viruses and negative virus groups, the single RSV group had a significantly younger age and significantly higher incidence rates of dyspnea, respiratory failure, and severe lower respiratory tract infection (P < 0.0083). The RSV-A positive group had a significantly higher proportion of boys than the RSV-B positive group (P=0.004), but there were no significant differences in clinical manifestations between the two groups. Conclusions In Chongqing in 2013-2018, RSV-A and RSV-B not only can predominate alternately, but also can co-circulate during a season. RSV is the major viral pathogen of hospitalized children with ALRI and can cause severe lower respiratory tract infection. There are no differences in clinical manifestations between children with RSV-A infection and those with RSV-B infection, but boys are more susceptible to RSV-A infection.

Key words： Respiratory infection Respiratory syncytial virus Epidemiological characteristic Child

收稿日期: 2020-07-19

基金资助:国家科技重大专项（2018ZX10713002-002-007；2017ZX10103010-003）；重庆市医学科研计划项目（渝卫科教[2012]33号-2012-2-083）。

通讯作者: 李渠北,男,副主任医师。Email:liqubei@126.com。 E-mail: liqubei@126.com

作者简介: 任康轶,女,硕士,住院医师。

引用本文:

任康轶,任洛,邓昱等. 2013~2018年重庆地区2 066例急性下呼吸道感染住院患儿呼吸道合胞病毒流行特征分析[J]. 中国当代儿科杂志, 2021, 23(1): 67-73.

REN Kang-Yi,REN Luo,DENG Yu et al. Epidemiological characteristics of respiratory syncytial virus in hospitalized children with acute lower respiratory tract infection in Chongqing, China, from 2013 to 2018: an analysis of 2 066 cases[J]. CJCP, 2021, 23(1): 67-73.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2007139 或 http://www.zgddek.com/CN/Y2021/V23/I1/67

[1]	Shi T, McAllister DA, O'Brien KL, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015:a systematic review and modelling study[J]. Lancet, 2017, 390(10098):946-958.
[2]	Anderson EJ, Carbonell-Estrany X, Blanken M, et al. Burden of severe respiratory syncytial virus disease among 33-35 weeks' gestational age infants born during multiple respiratory syncytial virus seasons[J]. Pediatr Infect Dis J, 2017, 36(2):160-167.
[3]	Pangesti KNA, Abd El Ghany M, Walsh MG, et al. Molecular epidemiology of respiratory syncytial virus[J]. Rev Med Virol, 2018, 28(2):e1968.
[4]	Griffiths C, Drews SJ, Marchant DJ. Respiratory syncytial virus:infection, detection, and new options for prevention and treatment[J]. Clin Microbiol Rev, 2017, 30(1):277-319.
[5]	江载芳, 申昆玲, 沈颖. 诸福棠实用儿科学[M]. 8版. 北京:人民卫生出版社, 2015:1251-1262.
[6]	Coiras MT, Pérez-Breña P, García ML, et al. Simultaneous detection of influenza A, B, and C viruses, respiratory syncytial virus, and adenoviruses in clinical samples by multiplex reverse transcription nested-PCR assay[J]. J Med Virol, 2003, 69(1):132-144.
[7]	Zheng SY, Wang LL, Ren L, et al. Epidemiological analysis and follow-up of human rhinovirus infection in children with asthma exacerbation[J]. J Med Virol, 2018, 90(2):219-228.
[8]	中华人民共和国国家健康委员会, 国家中医药局. 儿童社区获得性肺炎诊疗规范(2019年版)[J]. 中华临床感染病杂志, 2019, 12(1):6-13.
[9]	Bont L, Checchia PA, Fauroux B, et al. Defining the epidemiology and burden of severe respiratory syncytial virus infection among infants and children in western countries[J]. Infect Dis Ther, 2016, 5(3):271-298.
[10]	Anderson LJ, Dormitzer PR, Nokes DJ, et al. Strategic priorities for respiratory syncytial virus (RSV) vaccine development[J]. Vaccine, 2013, 31(Suppl 2):B209-B215.
[11]	谢正德, 肖艳, 刘春艳, 等. 儿童急性下呼吸道感染病毒病原学2007-2010年监测[J]. 中华儿科杂志, 2011, 49(10):745-749.
[12]	Pretorius MA, van Niekerk S, Tempia S, et al. Replacement and positive evolution of subtype A and B respiratory syncytial virus G-protein genotypes from 1997-2012 in South Africa[J]. J Infect Dis, 2013, 208(Suppl 3):S227-S237.
[13]	Houspie L, Lemey P, Keyaerts E, et al. Circulation of HRSV in Belgium:from multiple genotype circulation to prolonged circulation of predominant genotypes[J]. PLoS One, 2013, 8(4):e60416.
[14]	张拓慧, 邓洁, 钱渊, 等. 毛细支气管炎患儿呼吸道合胞病毒分子生物学及临床特征分析[J]. 中华儿科杂志, 2017, 55(8):586-592.
[15]	董琳, 歹丽红, 樊节敏, 等. 浙南地区下呼吸道感染儿童呼吸道合胞病毒基因型流行病学特征及与病情的关系[J]. 中华儿科杂志, 2015, 53(7):537-541.
[16]	Liu J, Mu YL, Dong W, et al. Genetic variation of human respiratory syncytial virus among children with fever and respiratory symptoms in Shanghai, China, from 2009 to 2012[J]. Infect Genet Evol, 2014, 27:131-136.
[17]	高钰, 王鹂鹂, 张瑶, 等. 呼吸道合胞病毒急性下呼吸道感染门诊患儿临床特征、住院及再发喘息随访研究[J]. 重庆医科大学学报, 2020, 45(6):776-781.
[18]	陈嘉韡, 顾文婧, 张新星, 等. 2013年至2015年苏州地区下呼吸道合胞病毒与鼻病毒感染婴儿的临床特征比较[J]. 中华实用儿科临床杂志, 2017, 32(16):1239-1243.
[19]	Petrarca L, Nenna R, Frassanito A, et al. Acute bronchiolitis:influence of viral co-infection in infants hospitalized over 12 consecutive epidemic seasons[J]. J Med Virol, 2018, 90(4):631-638.
[20]	Richard N, Komurian-Pradel F, Javouhey E, et al. The impact of dual viral infection in infants admitted to a pediatric intensive care unit associated with severe bronchiolitis[J]. Pediatr Infect Dis J, 2008, 27(3):213-217.
[21]	Papenburg J, Hamelin MÈ, Ouhoummane N, et al. Comparison of risk factors for human metapneumovirus and respiratory syncytial virus disease severity in young children[J]. J Infect Dis, 2012, 206(2):178-189.
[22]	Yoshihara K, Le MN, Okamoto M, et al. Association of RSV-A ON1 genotype with increased pediatric acute lower respiratory tract infection in Vietnam[J]. Sci Rep, 2016, 6:27856.
[23]	Vandini S, Biagi C, Lanari M. Respiratory syncytial virus:the influence of serotype and genotype variability on clinical course of infection[J]. Int J Mol Sci, 2017, 18(8):1717.
[24]	Wu W, Macdonald A, Hiscox JA, et al. Different NF-κB activation characteristics of human respiratory syncytial virus subgroups A and B[J]. Microb Pathog, 2012, 52(3):184-191.
[25]	Fonseca W, Lukacs NW, Ptaschinski C. Factors affecting the immunity to respiratory syncytial virus:from epigenetics to microbiome[J]. Front Immunol, 2018, 9:226.
[26]	Hornsleth A, Klug B, Nir M, et al. Severity of respiratory syncytial virus disease related to type and genotype of virus and to cytokine values in nasopharyngeal secretions[J]. Pediatr Infect Dis J, 1998, 17(12):1114-1121.
[27]	Fodha I, Vabret A, Ghedira L, et al. Respiratory syncytial virus infections in hospitalized infants:association between viral load, virus subgroup, and disease severity[J]. J Med Virol, 2007, 79(12):1951-1958.
[28]	Midulla F, Nenna R, Scagnolari C, et al. How respiratory syncytial virus genotypes influence the clinical course in infants hospitalized for bronchiolitis[J]. J Infect Dis, 2019, 219(4):526-534.
[29]	Papadopoulos NG, Gourgiotis D, Javadyan A, et al. Does respiratory syncytial virus subtype influences the severity of acute bronchiolitis in hospitalized infants?[J]. Respir Med, 2004, 98(9):879-882.
[30]	Tse SM, Coull BA, Sordillo JE, et al. Gender-and age-specific risk factors for wheeze from birth through adolescence[J]. Pediatr Pulmonol, 2015, 50(10):955-962.