小儿呼吸道人偏肺病毒感染25例流行病学和临床特征分析

目的 探讨小儿呼吸道人偏肺病毒(human metapneumovirus,hMPV)的感染阳性率、流行病学及其临床特征.方法 2002年12月至2003年12月在本科固定时间收集新入院的急性呼吸道感染患儿的鼻咽分泌物,一式两份.1份采用免疫荧光快速诊断方法用于分析包括呼吸道合胞病毒(respiratory syncytial virus,RSV)、腺病毒(adenovirus)、流感病毒(influenza virus) A、B副流感病毒(parainfluenza virus)1、2、3 这7种常见呼吸道病毒;另1份采用RT-PCR的方法检测上述患儿鼻咽分泌物中hMPV的L基因和M基因,鼻病毒与冠状病毒的基因.结果 检出 hMPV阳性标本25例,阳性率为9.7%,主要分布在秋冬季;25例hMPV阳性标本中单纯hMPV感染10例,占40%,15例(60%)系hMPV与其他病毒合并感染,其中包括8例hMPV与RSV合并感染,hMPV与鼻病毒、冠状病毒合并感染各2例,3例标本同时检出hMPV、RSV、鼻病毒为阳性;分析hMPV阳性呼吸道感染患儿的临床特征:男:女=16:9,12例(48%)临床诊断为毛细支气管炎,9例(36%)临床诊断为肺炎,4例(16%)为哮喘急性发作患儿,除hMPV和其他病毒合并感染更容易出现发热外,单纯hMPV感染与hMPV与其他病毒混合感染在发病年龄、性别、病程及临床表现上无明显差异.结论 hMPV是小儿急性呼吸道感染的重要病原,可与呼吸道其他常见病毒混合感染,仅从临床表现上很难将hMPV感染与其他呼吸道病毒感染区别.

Clinical analyses on human metapneumovirus infection in acute respiratory tract of 25 children

Objective To investigate the positive rate,epidemiologic and clinical features of human metapneumovirus(hMPV) in children's respiratory tract.Method Nasopharyngeal aspirates(NPS) from 258 hospitalized children with respiratory diseases over 13 months from 2002 December to 2003 December in our hospital were collected.Rapid immunofluoresence method was used to diagnose respiratory syncytial virus(RSV),adenovirus,influenza A and B,and parainfluenza 1,2,3.Viral mRNAs from NPS was extracted.L and M gene of hMPV,coronavirus and rhinovirus were detected by RT-PCR.Results hMPV was detected in the NPS from 25(9.7%) children by PCR.hMPV infection was associated with clinical diagnosis of pneumonia(36%),asthma exacerbation(16%) and acute bronchiolitis.Fifteen children with hMPV infection were co-infected with RSV,rhinovirus,coronavirus and RSV plus rhinovirus respectively.hMPV viral activity peaked during the autumn-winter period in Chongqing.Conclusion These data suggest besides RSV,hMPV is the common pathogen of children with respiratory infection.hMPV could be co-infected with other viruses.Further study will be elucidated the sequela of single hMPV infection and co-infection with other viruses.