冬春季儿童、婴幼儿哮喘急性发作的呼吸道病毒病原学特征及临床研究

目的 了解北京地区冬春季儿童、婴幼儿哮喘急性发作时的呼吸道常见病毒——呼吸道合胞病毒（RSV）、流感病毒（IFA1、IFA3、IFB）、副流感病毒（PIF1、PIF3）、腺病毒（ADV）的感染情况及与临床症状和嗜酸细胞的关系。方法 对2000年11月至2001年3月及2001年11月至2002年3月，来首都儿科研究所哮喘中心就诊的哮喘急性发作的患儿176名，采用病毒分离及间接免疫荧光法，对鼻咽分泌物（nasopharyngeal secretions，NPS）中七种病毒抗原进行监测，并同时记录临床症状和用药情况及进行鼻咽分泌物和外周血中嗜酸细胞计数。结果 176例哮喘急性发作患儿NPS中，79例检测出病毒，阳性率为44．9％。其中RSV 66例，感染率为37．5％、IF7例（4．0％）、ADV6例（3．4％）及PIF4例（2．3％）。RSV占79例病毒感染患儿的83．5％；4例患儿同时测定出RSV和其他病毒混合感染。这些病毒在哮喘急性发作的患儿中检出率与年龄呈反比，小年龄组的患儿病毒感染多；检出病毒的患儿病情重，伴发热的患儿显著多于未检查出病毒的患儿。病毒感染与非感染组的NPS中嗜酸细胞数目检测无明显差别；但血中嗜酸细胞的数目，病毒检出阳性的患儿，较病毒测定阴性的患儿明显减少（t=2．676，P〈0．001）。结论 北京地区冬季近半数哮喘急性发作的患儿呼吸道病毒检测阳性，其中RSV是婴幼儿哮喘发作的主要感染病毒，引起较严重的临床症状；病毒检出阳性的患儿，血中嗜酸细胞的数目明显减少。

Survey of viral infection among children with asthma exacerbation in Beijing area during the winter and spring season

Objective To determine how often asthma exacerbation was caused by virus infections and to examine the relationship between clinical score and eosinophilia during the winter and the spring.Method Virus isolation and indirect immunofluorescence technique were used to detect respiratory syncytial virus(RSV),influenza virus,parainfluenza virus and adenovirus antigens of nasopharyngeal secretions(NPS)and counted eosinophils in blood and NPS in 176 children suffering from asthma attacks from November 2000 to March 2001 and November 2001to March 2002.Results Viruses were detected in 79 patients(44.9%)in NPS.Among them,RSV infection was the most frequent,37.5% of 66 patients.Influenza virus was found in 4.0%(7 patients),adenovirus in 3.4%(6 patients)and parainfluenza in 2.3%(4 patients).RSV/adenovirus were detected in 2 patients and RSV/parainfluenza in 2 ptients.There was an inverse relation between age and virus infection.The younger the age,the more viruses detected.NPS eosinophils count was not different in both groups,but virus infected patients had less eosinophils in their blood than the virus infected patients(P<0.001).Conclusion Virus infection is an important trigger of asthma attacks in winter.RSV infection was more likely to be associated with asthma exacerbation in infants and younger children.