【摘要】 目的了解北京单中心门诊和住院腹泻患儿腺病毒(Ad)检出情况及流行特征。方法收集2010年1月至2013年12月首都儿科研究所6岁以下门诊腹泻、因腹泻住院和在住院期间出现腹泻症状患儿的粪便标本,采用PCR法检测Ad基因组DNA,分析流行特征。结果进入本文分析腹泻患儿3 357例,门诊和住院腹泻患儿分别为862和2 495例。13 357例腹泻患儿粪便标本中Ad检测阳性341例(10.2%),门诊和住院腹泻患儿Ad检出率分别为8.1%(70/862)和10.9%(271/2 495);门诊腹泻患儿肠道Ad(EAd)40例,包括Ad41和40型别,非肠道Ad(NEAd)30例(42.9%),包括Ad31和Ad2等5种型别;住院腹泻患儿EAd 271例,包括Ad41和Ad40型别,NEAd 157例(57.9%),包括Ad31和Ad7等11种型别;门诊和住院腹泻患儿Ad和NEAd检出率差异均有统计学意义(P分别为0.022和0.002)。2Ad在门诊腹泻男女患儿中的检出率分别为9.0%和6.5%,在住院腹泻男女患儿中的检出率分别为11.7%和9.5%,差异均无统计学意义(P分别为0.206和0.086)。男女患儿Ad检出率在住院和门诊腹泻患儿间差异均无统计学意义(P分别为0.080和0.112)。3门诊腹泻患儿~6月龄、~1岁、~2岁和~6岁的Ad检出率分别为4.4%、7.7%、11.6%和12.3%,各年龄段Ad检出率差异有统计学意义(P=0.017)。住院腹泻患儿<28 d、~6月龄、~1岁、~2岁和~6岁的Ad检出率分别为4.4%、9.4%、13.2%、12.3%和13.4%,各年龄段Ad检出率差异有统计学意义(P=0.001)。4无论是门诊亦或住院腹泻患儿,全年各月均可见Ad检出。5Ad合并轮状病毒感染门诊腹泻患儿8/70例(11.4%),住院腹泻患儿29/271例(10.7%),差异无统计学意义(P=0.862)。结论北京单中心门诊和住院腹泻患儿中Ad检出率为10.2%,以EAd41型占优势,NEAd31型在儿童腹泻中的作用也不容忽视。更多还原

【Abstract】 Objective To describe the epidemiological and clinical features in outpatients and inpatients with acute diarrhea caused by adonovirus in Beijing. Methods Polymerase chain reaction( PCR) was employed to identify adenovirus in fecal samples by using DNA template obtained by improved DNA extraction method developed previously. PCR products with expected size were sequenced for adenovirus typing. After that,positive cases were measured by rotavirus antigen detection kit( colloidal gold method).Statistical analyses were performed by using SPSS software( version 19. 0). Results A total of 3 357 diarrheal patients were enrolled into the study,including 862 outpatients and 2 495 inpatients. 1The detection rate of adenovirus was 10. 2%( 341 /3 357).Adenovirus was positive in 70 cases( 8. 1%) of 862 outpatient diarrheal children including 40 cases of enteric adenovirus( EAd)and 30 cases of non-enteric adenovirus( NEAd),and in 271 cases( 10. 9%) of 2 495 inpatients with acute diarrhea including 114 cases of EAd and 157 cases of NEAd. Adenovirus serotype 41 and Ad40 were the dominant EAd among outpatients and inpatients.Ad31 and Ad2 were common NEAd serotypes among outpatients,and Ad31 and Ad7 common in inpatients. There was significant difference in detection rate of adenovirus( P = 0. 022) and NEAd( P = 0. 002). 2The detection rate of adenovirus in boys and girls of outpatients was 9. 0% and 6. 5%,and 11. 7% and 9. 5% of inpatients,respectively. There was no difference in sex for adenovirus infection among diarrheal children either in outpatients( P = 0. 112) or in inpatients( P = 0. 080). 3The detection rate of outpatients aged 0- 6 months,- 1 year,- 2 years and- 6 years was 4. 4%,7. 7%,11. 6% and 12. 3%,respectively andsignificant differences were found among different age groups( P = 0. 017). The detection rate of inpatients aged 0- 28 days,- 6months,- 1 year,- 2 years and- 6 years was 4. 4%,9. 4%,13. 2%,12. 3% and 13. 4%,respectively and with significant differences among age groups( P = 0. 001). 4 Seasonal variation in adenovirus detection rates was not found in outpatients or inpatients. 5Eight outpatients co-infected with rotavirus and 29 inpatients were positive for rotavirus at the same time. There was no significant difference( P = 0. 862) between outpatients( 11. 4%,8 /70) and inpatients( 10. 7%,29 /271). Conclusion EAd is still the dominant adenovirus serotype detected either in outpatient or in hospitalized diarrheal children in Beijing,and Ad41 is the dominant type. But the role of NEAd,especially the Ad31 cannot be ignored in children with acute diarrhea.更多还原