儿科重症监护室单一和多重呼吸道病毒感染对比分析

目的 探讨儿科重症监护室(PICU)患儿单一和多重呼吸道病毒感染情况的差异.方法 收集406例入住汕头大学医学院第二附属医院PICU合并有呼吸道感染患儿的咽拭子样本,采用多重PCR及常规PCR对咽拭子行16种呼吸道病毒检测,分析阳性病例的病毒感染情况及与患儿临床特征的关系.结果 406例样本中病毒检测阳性者252例,阳性率62.1％.阳性样本中,以其中鼻病毒(HRV)检出率最高,为105例(41.7％),其次为呼吸道合胞病毒(RSV)63例(25.0％)]和腺病毒(HADV)48例(19.0％)];单一病毒感染177例(70.2％),多重病毒感染75例(29.8％),包括66例双重病毒感染,9例三重病毒感染.多重病毒感染最多的病毒组合是HRV+RSV(16例).单一病毒感染和多重病毒感染的患儿中存在基础疾病的病例数分别为46例和6例,两者差异有统计学意义(x2=10.409,P＜0.01);而二者在性别、年龄、住院时间、上下呼吸道感染人数及小儿危重症评分上差异均无统计学意义(x2=3.430,Z=0.315,Z=0.336,x2=0.041,P均＞0.05).结论 呼吸道病毒是PICU中呼吸道感染性疾病的主要病原体之一;存在基础疾病的患儿以单一病毒感染为主,多重病毒与单一病毒感染对于疾病严重程度的影响没有明显差异.

Comparative analysis of single and multiple respiratory viral infections in pediatric intensive care unit

Objective To investigate the differences between single and multiple respiratory viral infections in pediatric intensive care unit (PICU) patients.Methods Oropharyngeal aspiration (OPA) specimens were collected from 406 children hospitalized in PICU of the Second Affiliated Hospital of Shantou University Medical College with respiratory infection.Multiple PCR and normal PCR were applied to detect 16 types of viruses from OPA,and then the clinical data of positive cases and its relationship with the disease severity were analyzed.Results There were 252(62.1％) positive cases detected among 406 PICU children.In children with virus positive infection,the most frequently observed pathogen was human rhinovirus (HRV)(105 cases,41.7％),followed by respiratory syncytial virus (RSV) (63 cases,25.0％) and human adenovirus (HADV)(48 cases,19.0％);single viral infections were identified in 177 cases (70.2％),and multiple viral infections were identified in 75 cases (29.8％) including 66 cases with co-infection and 9 cases with triple infection.Co-infection of RSV+HRV was the most common model (16 cases).The patients with single and multiple infections combining basic diseases accounted for 46 and 6 cases respectively,and the difference had statistical significance (x2=10.409,P＜0.01).There were no significant differences in sex,age,hospitalization duration,upper/lower respiratory infections and Chinese Pediatric Critical Illness Score (PCIS) between patients with single and multiple respiratory viral infections (x2=3.430,Z=0.315,Z=0.336,x2=0.041,P all ＞0.05).Conclusions Respiratory virus is one the most common pathogens causing respiratory infections in PICU.Children with underlying disease are more vulnerable to single respiratory viral illness.There is no significant difference between single and multiple infections for the disease severity.