摘要
目的了解上海部分地区全年儿童急性下呼吸道感染（ALRTI）的病原谱及临床流行病学特征，为临床抗感染及病原检测提供依据。方法933例复旦大学附属儿科医院2007年1月至12月ALRTI住院患儿，负压吸取咽部以下深部痰液1～2mL，作细菌培养，并检测呼吸道合胞病毒（RSV），腺病毒（ADV），A、B型流感病毒（IFV）．1、2及3型副流感病毒（PIV）等7种常见呼吸道病毒抗原。实时荧光定量PCR检测人偏肺病毒（hMPV）RNA及支原体和衣原体DNA。结果99．9份ALRTI儿童痰标本中，细菌培养阳性225份，病毒检测阳性316份，支原体和衣原体阳性分别是74份与31份。混合感染标本118份，总标本病原学检出率为53．9％。RSV阳性标本26g份，为最重要的感染病膊，冬季为RSV感染高峰，3月龄以下儿童检出率为36．4%，3足月到6月龄以下儿童检出率为19．5％，2岁以下儿童占92．5％。RSV阳性标本中，79．5％的患儿有喘息表现。330份7种常见病毒俭测阴性标本中。hMPV检出率为2．1%,患儿均无喘息表现。检出大肠埃希菌40株、肺炎克雷伯菌33株、肺炎链球菌32株、金黄色葡萄球菌20株、凝固酶阴性葡萄球菌19株、流感嗜血杆菌和副流感嗜血杆菌分别为17株和16株、卡他莫拉菌布兰汉亚种16株、铜绿假单胞菌15株，为主要的致病菌。975份标本中支啄体和衣原体检出率分别为7．6％和3．2％。结论RSV仍为儿童ALRTI最主要的病原，尤其在2岁以下儿童。RSV感染易表现为儿童喘息发作．冬季为流行高峰。2007年hMPV流行强度较弱。上海部分地区仍有40%以上ALRTI患儿感染病原未明。
Objective To investigate the etiology and clinical characteristics of hospitalized children with acute low respiratory tract infection （ALRTI） in Shanghai area. Methods Nine hundred and ninety two sputum samples were collected from 933 cases of ALRTI who were hospitalized in Children＇s Hospital of Fudan University during January 2007 to November 2007. Bacterial culture was performed with sputmn samples. Direct immunofluorescence assay （DFA） was applied to identify 7 different kinds of viruses, i.e. respiratory syncytial virus （RSV）, influenza virus （IFV） type A and type B, parainf[uenza virus （PIV） type 1, 2, .3 and adenovirus （Af）V）. A TaqMan minor groove binger （MGB） based real-time quandtatNe reverse transcriptase polymerase chain reaction （qRT-PCR） assay targeting at the nucleoprolein （N） gene was developed for detecting human metapneumovirus （hMPV） RNA, Mycoplasma pneumonia DNA and Clamydia pneumonia DNA. Results Among the 992 samples from the children with ALRTI, 225 samples were positive for bacteria, 323 samples were positive for viruses, 74 samples were positive for Mycoplasma pneumonia and 31 samples were positive for Clamydia pneumonia. One hundred and eighteen samples were determined as mixed infection. The pathogen positive rate among all these samples was 53. 9%. Two hundred and sixty eight samples were positive for RSV, which was the dominant pathogen in 2007. Nearly 92.5% RSV infected cases were found in children younger than two years old and 79.5% RSV victims suffered from＇wheezing＇ symptom. The hMPV positive rate among 330 samples that were negative for 7 common viruses was 2.1%. None hMPV infected children developed wheezing symptoms. The most common bacterial pathogens included E. coli, K. pneumoniae, S. pneumoniae, S. aureus, coagulase negative Staphylococci, H. influenzae, H. parainjluenzae, M. catarrhalis and P. aeruginosa, which were detected in 40, 33, 32, 20,19, 17, 16, 16 and 15 samples, respectively. Mycoplasma and Clamydia positive rates among 975 samples were 7. 6% and 3. 2% respectively. Conclusions RSV is still a major cause of acute low respiratory tract infection in children, especially in infants and younger children. RSV infected patients are prone to develop wheezing symptom. The incidence of hMPV infection is low in Shanghai during 2007. However, pathogens are still undetermined in more than 40% of cases of acute low respiratory tract infection.
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2009年第11期668-672,共5页
Chinese Journal of Infectious Diseases
关键词
急性病
呼吸道感染
儿童
住院
流行病学研究
Acute disease
Respiratory tract infections
Child, hospitalized
Epidemiologic studies
