【作者】 李莉；

【导师】 严永东；

【作者基本信息】 苏州大学 ， 儿科学（专业学位）， 2015， 硕士

【摘要】 目的了解苏州地区人鼻病毒(Human rhinovirus,HRV)及鼻病毒C组(HRV-C)在呼吸道感染(respiratory tract infections,RTIs)住院患儿中检出情况、流行特点及临床特征。方法搜集2013年1月~2014年12月于苏州大学附属儿童医院呼吸科住院的呼吸道感染儿童的鼻咽深部吸取物3430份,提取呼吸道标本RNA,采用反转录聚合酶链式反应(Reverse transcription polymerase chain reaction,RT-PCR)检测HRV RNA,对2014年1月~2014年12月的HRV阳性标本c DNA,采用实时荧光PCR+高分辨熔链曲线分析检测HRV-C,分析HRV及HRV-C呼吸道感染的流行病学特点;同时对RTIs患儿的呼吸道标本采用直接免疫荧光法进行呼吸道合胞病毒(Respiratory syncytial virus,RSV)、流感病毒A、B型(Influenza virus types A,B;Inf A,B)、副流感病毒1-3型(Parainfluenza virus types 1-3;Pinf 1-3)、腺病毒(Adenovirus,ADV)检测,实时荧光PCR检测人博卡病毒(Human bocavirus,HBo V)、肺炎支原体(Mycoplasma pneumonia,MP),RT-PCR检测人偏肺病毒(Human metapneumovirus,h MPV);痰培养检测细菌。结果1、HRV及HRV-C检出情况:3430例呼吸道感染住院患儿共检出1339株病毒株(39.0%),HRV检出439例(12.8%),其中2013年度HRV检出195例(11.3%),2014年度HRV检出244例(14.3%);2014年244例HRV阳性患儿检出HRV-C型69例,占总HRV 28.3%。2、混合感染检出情况:HRV混合病毒感染70例(70/439,16.0%),以HRV混合HBo V多见(30/70,43.5%);混合细菌感染170例(170/439,38.7%),以HRV混合肺炎链球菌最多见(69/170,40.6%);混合肺炎支原体感染187例(187/439例,42.6%);HRV-C混合病毒感染6例(3份HBo V,1份RSV,1份Pinf-3,1份HBo V+RSV);混合细菌感染32例,以混合肺炎链球菌最常见(9例);混合肺炎支原体感染26例。3、流行特点:HRV全年散发,在9月份达高峰,春、夏、秋三季检出率明显高于冬季(P均<0.005);男女检出率无显著差异(?2=1.728,P=0.189);70.4%HRV感染患儿在2岁以下,随年龄的增长有下降趋势,各年龄组HRV检出阳性率未见显著差异(?2=3.343,P=0.342);HRV-C在每个月份均有检出,10、11月检出较多,秋季检出阳性率显著高于春、夏、冬季(P均<0.005);2~5岁组HRV-C检出率显著高于其他年龄组(P<0.05)。4、临床特征:呼吸道HRV感染可表现为发热、咳嗽、喘息等,与RSV比较更易出现发热(?2=14.860,P<0.001),但RSV感染比HRV感染更易出现喘息(?2=9.141,P=0.002)。在大叶性肺炎及哮喘急性发作中,HRV阳性检出高于其他常见呼吸道病毒;在毛细支气管炎中,HRV阳性检出仅次于RSV感染;HRV-C感染与HRV-A/B感染在性别分布、临床表现未见显著差异(P>0.05);HRV-C感染致大叶性肺炎和哮喘急性发作的比例显著大于HRV-A/B(P<0.05)。结论HRV是苏州地区呼吸道感染的主要病毒病原之一,全年散发,9月份达高峰,以2岁以下儿童为主;HRV-C感染约占HRV的1/3,全年散发,10、11月达高峰,以2~5岁组检出率最高,临床表现与HRV-A/B相似,但致大叶性肺炎和哮喘急性发作的比例较HRV-A/B高。更多还原

【Abstract】 Objective To investigate the frequency and clinical characteristics of human rhinovirus(HRV) and human rhinovirus C in hospitalized children with respiratory tract infections(RTIs) in Suzhou.Methods From Jan 2013 to Dec 2014, 3430 nasal aspirate specimens from children with RTIs were obtained, RNA was extracted from the specimens and reverse transcription polymerase chain reaction(RT-PCR) was performed for HRV RN A. HRV-C was detected by the real-time fluorescent PCR and high resolution melting curve for the HRV positive specimens from Jan 2014 to Dec 2014.Medical records of patients with a positive test for HRV and HRV-C in RTIs patients were analyzed. Direct immuno-fluorescence assay was done directly on the respiratory specimens from RTIs and tested for respiratory syncytial virus(RSV), influenza virus types A, B(Inf-A, B), parainfluenza virus types 1-3(Pinf 1-3), and adenovirus(ADV). Using real-time PCR method for human bocavirus(HBo V) and mycoplasma pneumonia(MP), and RT-PCR for human metapneumovirus(h MPV). putum culture was applied to detect bacterial.Results 1. From the 3430 RTIs specimens, 1339 viruses were detected(39.0 %), 439 HRV(12.8%), including 195 HRV(11.3%) o f 2013, 244 HRV(14.3%) of 2014. 244 HRV positive specimens were detection HRV-C 69, accounting for 28.3% of the total HRV.2. The detection of coinfections: HRV coinfections with virus were detected in 70 patients(70/439,16.0%), with HBo V as the most frequent virus coinfections(30/70, 43.5%). HRV coinfections with bacterial were detected in 170 patients(170/439, 38.7%), with streptococcus pneumoniae as the most frequent bacterial coinfections(69/170,40.6%). HRV coinfections with mycoplasma pneumonia were detected in 187 patients(187/439,42.6%)). HRV-C coinfections with virus were detected in 6 patients(3 HBo V,1 RSV,1 Pinf-3,1 HBo V+RSV). HRV-C coinfections with bacterial were detected in 32 patients, with streptococcus pneumoniae as the most frequent bacterial coinfections(9 case). HRV-C coinfections with mycoplasma pneumonia were detected in 26 patients.3. HRV distributed sporadically throughout the year, with a peak in September. The detection rate was higher in spring,summer and autumn seasons than winter(P<0.005). There was no statistically significant differences between males and females(c2 =1.728,P=0.189), majority of the infected children was under 2 years old(70.4%), and the positive number decreased gradually with age. The HRV detection positive ra te has no statistically significant difference between age groups((c2 =3.343,P=0.342). HRV-C distributed sporadically throughout the year, with a peak in October and November. The detection rate was higher in autumn seasons than spring, summer and winter(P<0.005). The rate of children infected HRV-C between 2~5 years old was significantly higher than other age groups(P<0.05).4. The clinical manifestations of HRV were similar to ot her viruses, presented with fever, cough and wheezing. Compared with RSV intection,HRV intection was more susceptible to have fever(c2 =14.860,P<0.001), but RSV infection were more likely to appear breathing(c2 =9.141,P=0.002).In patients diagnosed with lobar pneumonia or asthma, HRV was detected more frequently than other common viruses, and was second to RSV infection in bronchiolitis. There was no statistical difference between HRV infection with HRV-A/B infection in gender and clinical manifestations(P>0.05). In patients diagnosed with lobar pneumonia or asthma, HRV-C was detected more frequently than HRV-A/B(P<0.05).Conclusion HRV was a major viral pathogen of RTIs in Suzhou, sporadically distributed throughout the year with a peak in September, mainly infected children less than 2 years old. HRV-C infection accounted for about 1/3 of the HRV, sporadically distributed throughout the year with a peak in October and November. The rate of children infected HRV-C between 2~5 years old was the highest. The clinical features were similar with HRV- A/B. In patients diagnosed with lobar pneumonia or asthma, HRV-C was detected more frequently than HRV-A/B.更多还原