小儿肺炎的病毒性病原学研究

目的:探讨小儿肺炎的病毒性病原学特点.方法:应用直接免疫荧光法,连续3年对13 642例住院肺炎患儿呼吸道分泌物中呼吸道合胞病毒(RSV),副流感病毒(PIV) 1、2、3型,流感病毒(IV)A型、B型和腺病毒(ADV)抗原进行检测.结果:病毒性肺炎占34.3%,其中RSV占25.8%,PIV4.7%,IV A 2.4%,IV B 0.2%,ADV 1.3%.RSV在≤1岁组检出率 33.1%,>1～3岁组19.7%,>3岁组5.1%(趋势χ2=763.4,P<0.001).ADV肺炎,>1～3岁组与>3岁组分别为2.3%及2.5%,均高于≤1岁组的0.7%(P<0.01).>1～3岁组IV A检出率3.4%,高于≤1岁组(χ2=18.2,P<0.01).>1～3岁组PIV 1肺炎占1.2%,较其它年龄组高(P<0.05).PIV 3,≤1岁组检出率 4.7%,>1～3岁组3.2%,>3岁组1.4%(趋势χ2=52.4,P<0.01).RSV感染率11月开始明显增高,持续到次年的3～4月份,但每年仍有差别.肺炎中RSV月感染率最高62.8%,IV A达15.7%.结论:小儿肺炎的病毒性病原,感染率高低依次为RSV、PIV、IV和ADV.RSV、PIV 3,年龄越大检出率越低.≤1岁婴儿ADV感染较少.幼儿较婴儿易致IV A感染.RSV流行见于冬春季,但存在变化.

Viral etiology of pneumonia in children

OBJECTIVE: To evaluate the viral pathogen of pneumonia in children. METHODS: A total of 13 642 cases of children pneumonia in 3 years were enrolled in this study. Antigens of viral pathogen in respiratory excretion, including respiratory syncytial virus (RSV), type 1, 2 and 3 parainfluenza virus, type A and B influenza virus, and adenovirus were detected by direct immunofluorescence method. RESULTS: Viral pneumonia accounted for 34.3% of all cases, including 25.8% cases of RSV, 4.7% of parainfluenza virus, 2.4% of type A influenza virus, 0.2% of type B influenza virus and 1.3% of adenovirus. Coinfection was found in 20 cases, in which 17 cases (85%) were infected with RSV and another virus. Positive rates of RSV in children < or = 1 year, 1 to 3 years, and >3 years were 33.1%, 19.7% and 5.1% with a significant difference (chi(2)(trend)=763.4, P < 0.001). The positive rate of adenovirus in children < or =1 year (0.7%) was significantly lower than that in children aged 1 to 3 years and in children >3 years (2.3% and 2.5%) (all P<0.01). The positive rate of type A influenza virus in children aged 1 to 3 years was higher than that in children < or =1 year (chi(2)=18.2, P<0.01). Type 1 parainfluenza virus was found in 1.2% children aged 1 to 3 years with most prevalence (P<0.05). Infection rates of type 3 parainfluenza in children < or =1 year, 1 to 3 years, and >3 years were 4.7%, 3.2% and 1.4% respectively with a significant difference (chi(2)(trend)=52.4, P<0.01). Although there were some differences of infection rate of RSV in different years, it tended to increase from November to next April with a highest rate of 62.8%. Type 3 parainfluenza virus and Type A influenza virus were almost sporadic while type A influenza virus was epidemic in August 2003 with an infection rate of 15.7%. CONCLUSION: The highest infection rate of viral pathogen of pneumonia in children is RSV and the follows are parainfluenza, influenza and adenovirus in turn.