摘要
目的探讨广州社区获得性肺炎(community acquired pneumonia,CAP)住院儿童人偏肺病毒(HMPV)流行病学特点。方法以2010年1月至2018年12月广州医科大学附属第一医院儿科8 313例CAP住院患儿为观察对象,取咽拭子为标本,采用实时荧光定量PCR法检测HMPV、流感病毒A(influenza virus A,infA)、流感病毒B(influenza virus B,infB)、呼吸道合胞病毒(respiratory syncytial virus,RSV)、副流感病毒(parainfluenza virus,PIV)1~4型、腺病毒(adenovirus,ADV)、鼻病毒(rhinovirus,HRV)、肠病毒(entero virus,EV)、人博卡病毒(human bocavirus,HBoV)、冠状病毒(coronavirus,CoV)。结果CAP住院患儿HMPV检出率为2.68%(223/8 313)。不同年份HMPV检出率存在差异(χ2=96.16,P<0.000 1)。2010-2018年9年间HMPV检出率呈波浪状变化。不同年龄段CAP住院患儿HMPV检出率存在差异,1~3岁年龄段检出率最高(χ2=26.751,P<0.000 1)。CAP住院患儿HPMV检出率以春季最高,其次为冬季(χ2=81.503,P<0.000 1)。重症肺炎患儿HMPV检出率2.2%。HMPV阳性CAP患儿中6.73%表现为重症肺炎,HMPV阴性CAP患儿中8.23%表现为重症肺炎,两者比较差异无统计学意义(χ2=0.654,P=0.419)。18.83%HMPV阳性CAP住院患儿同时检出其他病毒,其中以冠状病毒、RSV最多见。CAP住院患儿病毒检出率41.68%,不同年份病毒检出率存在差异(χ2=141.927,P<0.000 1),2010-2018年9年间病毒检出率呈波浪状变化。不同年龄段病毒检出率存在差异,1~3岁年龄段检出率最高(χ2=204.904,P<0.000 1)。CAP住院患儿春季病毒检出率最高(χ2=72.696,P<0.000 1)。重症肺炎患儿病毒检出率47.28%较非重症肺炎患儿41.18%高(χ2=9.575,P=0.002)。结论广州CAP住院儿童病毒检出率高,HMPV检出率低;病毒、HMPV检出率呈波浪状变化,存在年度差异;1~3岁儿童是病毒、HMPV感染致CAP的重点防控人群;春季是广州地区病毒致CAP的重点防控季节;春季、冬季是广州地区HMPV致CAP的重点防控季节。病毒感染可能与CAP患儿发展为重症肺炎有关。HMPV可能并非重症肺炎的主要病原。
Objective To investigate the epidemiological characteristics of human metapneumovirus(HMPV)in children with community acquired pneumonia(CAP)in Guangzhou.Methods Hospitalized children with CAP in the department of pediatrics of the first affiliated hospital of Guangzhou medical university from January 2010 to December 2018 were observed.Pharyngeal swab specimens were collected and tested for HMPV,infA,infB,RSV,PIV1,PIV2,PIV3,PIV4,ADV,HRV,EV,HBoV,CoV using RT PCR method.Results HMPV was detected in 2.68%of the hospitalized children with CAP.The HMPV positive rates varied in different years(P<0.05).From 2010 to 2018,the positive rates of HMPV in hospitalized children with CAP showed wavy change.The positive rate of HMPV was the highest in 1~3 years old group(P<0.05).The positive rate of HMPV was highest in spring,and then in winter(P<0.05).The positive rate of HMPV in children with severe pneumonia was 2.2%.6.73%of HMPV positive CAP children showed severe pneumonia,and 8.23%of HMPV negative CAP children showed severe pneumonia.There were no significant difference between the two groups(χ2=0.654,P=0.419).Other viruses were also detected in 18.83%of hospitalized children with HMPV positive CAP.At lease one virus was detected in 41.68%of hospitalized children with CAP.Virus positive rates varied in different years(χ2=141.927,P<0.000 1).From 2010 to 2018,the positive rates of virus in hospitalized children with CAP showed wavy changes.The virus positive rate was the highest in 1~3 years old group(χ2=204.904,P<0.000 1).The virus positive rate in spring was the highest(χ2=72.696,P<0.000 1).The positive rate of virus in children with severe pneumonia was 47.28%higher than that in children with non severe pneumonia(41.18%)(χ2=9.575,P=0.002).Conclusions The positive rate of virus is high in hospital children with CAP in Guangzhou.The positive rate of HMPV is low in hospitalized children with CAP in Guangzhou.The positive rates of virus and HMPV show wavy change,with annual difference.Children aged 1~3 years old are the key population of CAP caused by virus and HMPV.Spring is the key seasons for prevention and control of CAP caused by virus in Guangzhou.Spring and winter are the key seasons for prevention and control of CAP caused by HPMV in Guangzhou.Virus infection may be associated with the development of severe pneumonia in children with CAP.HMPV may not be the main patho gen of severe pneumonia.
作者
蔡勇
黄楚鑫
周蕾
刘升
王丹瑜
蒋惠
梁文雅
刘文宽
陈德晖
CAI Yong;HUANG Chuxin;ZHOU Lei;LIU Sheng;WANG Danyu;JIANG Hui;LIANG Wenya;LIU Wenkuan;CHEN Dehui(Department of Pediatrics,the First Affiliated Hospital,Guangzhou Medical University,Guangzhou 510120,China)
出处
《实用医学杂志》
CAS
北大核心
2019年第19期3094-3097,共4页
The Journal of Practical Medicine
基金
国家自然科学基金面上项目（编号：81970003）
国家科技重大专项（编号：2018ZX10102001,2017ZX10103011）
广州市科技计划项目（编号：201803040004）
