长沙地区急性下呼吸道感染儿童呼吸道合胞病毒、偏肺病毒临床特征及流行状况分析

目的了解长沙地区急性下呼吸道感染（ALRTI）儿童呼吸道合胞病毒（RSV）及人偏肺病毒（hMPV）的流行病学特点和临床特征。方法收集2007年9月-2008年8月湖南省人民医院儿科医学中心1 165例ALRTI住院儿童鼻咽抽吸物样本,进行RSV及hMPV基因检测。对RSV和hMPV感染患儿流行病学特点、临床表现及实验室检查结果等进行比较。结果 1 165例样本检出RSV阳性标本315例,检出率为27.04%,1岁以下患儿占64.1%;hMPV阳性76例,检出率为6.52%,1岁以下患儿占63.15%;RSV感染全年均有发生,第一年11月到次年2月份为检出高峰,hMPV的检出高峰在3-4月;RSV感染病例气促的发生率高于hMPV感染病例（P〈0.05）,发热、喘息、呕吐、腹泻的发生率两种病毒间差异无统计学意义（P〉0.05）;RSV、hMPV感染病例白细胞、C-反应蛋白、转氨酶及心肌酶等实验室指标变化比较差异无统计学意义（P〉0.05）;影像学检查同以散在肺部实变或间质病变为主,鲜有累及大片肺叶及胸膜。14例患儿同时存在RSV及hMPV感染,混合感染率1.20%（14/1 165）。RSV及hMPV协同感染患儿发绀几率较单一RSV感染患儿高（P〈0.05）,白细胞升高几率大于单一感染者（P〈0.05）,而喘息、气促、呕吐、腹泻发生率及C-反应蛋白、转氨酶、心肌酶等实验室检测指标变化与单一RSV或hMPV感染比较差异无统计学意义（P〉0.05）;单一hMPV感染患儿的发热率高于单一RSV感染或两者协同感染患儿（P〈0.05）。单一感染和协同感染病例间病程、住院天数及预后比较差异无统计学意义（P〉0.05）。结论 RSV及hMPV均是引起长沙地区婴幼儿下呼吸道感染的重要病原,流行季节相近,具有相似的临床特征及影像改变,临床上难以鉴别。RSV感染较hMPV感染患儿更易发生气促,而hMPV感染则相对更易出现发热症状。混合hMPV感染可能有加重RSV感染患儿呼吸道症状的趋势。

Analysis of Epidemiological Characteristics and Clinical Features of Respiratory Syncytial Virus and Human Metapneumovirus in Children with Acute Lower Respiratory Tract Infection in Changsha

Objective To explore the epidemiological characteristics and clinical features of respiratory syncytial virus(RSV) and human metapneumovirus(hMPV) in children infected with acute lower respiratory tract infection(ALRTI) in Changsha.Methods A total of 1,165 nasopharyngeal aspirates(NPAs) specimens were collected from children with ALRTI hospitalized in the Pediatric Medicine Center of Hunan Provincial People’s Hospital between September,2007 and August,2008.Genes of RSV and hMPV in the NPAs were detected by RT-PCRs.The epidemiological characteristics,clinical feature and laboratory results were compared among children with ALRTI caused by RSV,by hMPV and by both.Results RSV was detected in 315 of 1,165 patients(27.04%),with 64.1% younger than one year old,while hMPV was identified in 76 of these patients(6.52%),with 63.15% younger than one year old.RSV infection occurred throughout a year,with a peak from December of the first year to February of the next year,while hMPV infection was mainly detected from March to April.The RSV infected children were more likely to have tachypnea than the hMPV infected(P<0.05).There were no significant differences between RSV and hMPV infected children regarding the incidence of fever,wheezing,vomiting or diarrhea,nor were the abnormal changes of WBC,CRP,ALT or CK-MB(P>0.05).Image examination indicated that both infections mainly showed interspersed solidification and interstitial damage in the lung.Large patchy shadows in the lung and pleural lesions were rarely detected.Fourteen patients were identified to be simultaneously infected with RSV and hMPV,with a co-infection rate of 1.20%(14/1165).The incidence of cyanosis in the co-infection cases was significantly higher than that in the pure RSV infection,while the incidences of wheezing,tachypnea,vomiting,diarrhea and elevated CRP,ALT and CK-MB did not indicate any significant difference between co-infection and both single-infections(P>0.05).Children with single-infection of hMPV were more likely to get fever than children with single-infection of RSV and children with co-infection,while children with co-infection more likely had elevated WBC than both those with single-infections(P<0.05).The course,hospitalization days and prognosis were not statistically different among single-infections and co-infection(P>0.05).Conclusions Both RSV and hMPV are important pathogens of ALRTI in children in Changsha.They are similar in many ways,such as prevalence season,clinical feature and image changes.RSV infection is more likely to lead to tachypnea,while hMPV infection is more likely to lead to fever.Co-infection with hMPV may aggravate respiratory symptoms of RSV infection.