摘要
目的 了解人类博卡病毒（HBoV）在儿童急性呼吸道感染中的检出情况,并探讨HBoV载量与儿童急性呼吸道感染临床特征的相关性.方法 收集苏州大学附属儿童医院呼吸科2013年1月至6月因急性上、下呼吸道感染住院的4 105例患儿的鼻咽部分泌物.将入院后HBoV检测阳性的患儿分单纯感染组和混合感染组.再将HBoV DNA载量≥1×104拷贝/mL者归为高病毒载量组,HBoV DNA＜1×104拷贝/mL者归为低病毒载量组.采用PCR-荧光探针法检测HBoV;直接免疫荧光法检测呼吸道合胞病毒、流行性感冒病毒（流感病毒）、副流感病毒和腺病毒抗原;实时荧光定量PCR检测肺炎支原体;血清ELISA检测支原体抗体,并做痰细菌培养.选取同期23例无呼吸道症状及发热、外科择期腹股沟斜疝手术的患儿作为对照组,采用流式细胞仪检测外周血T淋巴细胞亚群的百分比.组间率的比较采用x2检验或Fisher确切概率法,病毒载量比较采用Mann-Whitney秩和检验.结果 HBoV阳性222例,检出率为5.41％（222/4 105）,其中高病毒载量病例占33.33％（74/222）,低病毒载量病例占66.67％（148/222）.HBoV感染以1～2岁儿童多见.单纯HBoV感染者占24.32％（54/222）,其中高病毒载量26例,低病毒载量28例,高病毒载量患儿临床表现为喘息者明显多于低病毒载量（88.46％比47.86％）,两组差异有统计学意义（x2=12.295,P=0.001）.222例HBoV阳性患儿中,单纯HBoV感染组病毒载量中位数为3.86×10 3拷贝/mL,混合感染组病毒载量中位数为1.0×102拷贝/mL,两组差异有统计学意义（Z=2.906,P=0.004）.168例混合感染组患儿病原学检查主要为肺炎支原体和肺炎链球菌.单纯感染组与混合感染组患儿的CD3＋、CD3＋/CD8＋T淋巴细胞亚群百分比明显低于对照组（均P＜0.05）;而CD3＋/CD19＋、CD19＋/CD23＋T淋巴细胞亚群百分比高于对照组（均P＜0.05）.结论 HBoV是引起儿童急性呼吸道感染的病原体之一,可导致患儿细胞免疫功能紊乱,且HBoV载量愈高,愈能引起婴幼儿发生喘息.对于HBoV低病毒载量的患儿,要考虑存在其他病原体混合感染可能.
Objective To investigate the detection of human bocavirus （HBoV） in children with acute respiratory infection and to explore the relationship between viral load and clinical characteristics of acute respiratory infection in children.Methods A total of 4 501 nasopharyngeal secretion samples were collected from hospitalized children with acute respiratory infection from January 2013 to June 2013.HBoV-positive children were divided into simple infection group and mixed infection group.Children with HBoV DNA≥1 × 104 copy/mL were categorized into high viral load group,while those with HBoV DNA ＜1 × 104 copy/mL were categorized into low viral load group.HBoV was determined by fluorescence quantitative polymerase chain reaction （PCR）.Respiratory syncytial virus （RSV）,influenza virus （Inf）-A,Inf-B,parainfluenza virus （Pinf）-Ⅰ 、Pinf-Ⅱ 、Pinf-Ⅲ and adeno virus antigen were detected by direct antigen-specific immunofluorescence assays.Mycoplasm Pnuemonia was detected by real-time fluorescence quantitative PCR.Serum mycoplasma antibodies were detected by enzyme-linked immunosorbent assay （ELISA）.Bacteria was detected by sputum culture.Over the same period,23 children undergoing elective inguinal hernia operation with no respiratory infection or fever were considered as control group.The percentage of peripheral blood T lymphocyte subsets were tested by flow cytometry.Inter-group differences were compared using Chi-square test or Fisher exact test.Viral loads were compared using Mann-Whitney test.Results Two hundred and twenty-two HBoV-positive cases were detected with a positive rate of 5.41％ （222/4 105）,33.33％ （74/222） of which were with high viral load and 66.67％ （148/222） were with low viral load.There was a high incidence in the age group of 1-2 years.The simple HBoV infection accounted for 24.32％,including 26 cases with high viral load and 28 cases with low viral load.Wheezing was more common in patients with high viral load than those with low viral load,and the difference was statistically significant （88.46 ％ vs 42.86 ％,x2 =12.295,P=0.001）.Among the 222 HBoV-positive cases,the median viral load of HBoV in simple infection group was 3.86 × 103 copy/mL,and 1.0× 103 copy/mL in mixed infection group.The difference of the viral load between these two groups was statistically significant （Z =2.906,P =0.004）.Mycoplasma and Streptococcus pneumonia were most commonly detected in the 168 patients with mixed infection.Percentages of CD3＋ and CD3＋/CD8＋ subsets were significantly lower in HBoV simple infection group and mixed infection group,compared to control group （both P＜0.05）.However,percentages of CD3 /CD19＋,CD19＋/ CD23＋ subsets were significantly higher in HBoV simple infection group and mixed infection group,compared to control group （both P＜0.05）.Conclusions HBoV is one of the pathogens causing acute respiratory tract infection in children,which lead to cellular immunity dysfunction in children.Moreover,children with higher HBoV load are more likely to develop wheezing.Co-infection with other pathogens should be considered in children with low HBoV load.
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2014年第6期343-348,共6页
Chinese Journal of Infectious Diseases
基金
江苏省社会发展项目资助（BE2012652）
关键词
呼吸道感染
博卡病毒属
儿童
病毒载量
临床特征
Respiratory tract infections
Bocavirus
Child
Viral load
Clinical characteristics
