2013~2018年重庆地区2 066例急性下呼吸道感染住院患儿呼吸道合胞病毒流行特征分析

Epidemiological characteristics of respiratory syncytial virus in hospitalized children with acute lower respiratory tract infection in Chongqing, China, from 2013 to 2018: an analysis of 2 066 cases

摘要:

目的 研究急性下呼吸道感染住院患儿呼吸道合胞病毒（RSV）检出率、流行规律及临床特征。方法 收集2013年6月至2018年5月于重庆医科大学附属儿童医院呼吸中心住院的2岁以下急性下呼吸道感染（ALRI）患儿鼻咽抽吸物，采用多重PCR检测16种常见呼吸道病毒，分析RSV流行特征。结果 共纳入2 066例ALRI住院患儿，病毒检出阳性1 595份（77.20%）。其中RSV阳性检出826份（39.98%）。RSV阳性样本中，RSV-A阳性410份（49.6%），RSV-B阳性414份（50.1%），RSV-A与RSV-B均阳性2份（0.2%）。2013~2014年、2016~2017年主导流行亚型为RSV-B，2014~2015年、2017~2018年以RSV-A为主要检出亚型，2015~2016年为RSV-A与RSV-B共同流行。冬季检出率最高。RSV合并人鼻病毒为最常见的2种病毒混合检出组合（123份）。该组患儿较单一RSV检出患儿更易出现喘息（P=0.030）。在2 066例患儿中，单一RSV检出298份，RSV混合其他病毒检出148份，其他病毒检出389份，病毒检出阴性241份。RSV单一检出组较其他病毒检出组和病毒检出阴性组月龄更小，更易发生呼吸困难、呼吸衰竭及重症下呼吸道感染（P < 0.0083）。RSV-A阳性患儿中的男性比例高于RSV-B阳性患儿（P=0.004），而临床表现二者未见显著差异。结论 2013~2018年重庆地区RSV-A与RSV-B既可分别主导流行，也可共同流行；RSV为急性下呼吸道感染住院患儿最主要病毒病原，易导致重症下呼吸道感染；RSV-A和RSV-B感染患儿临床表现无差异，但RSV-A更易感染男性患儿。

Abstract:

Objective To study the detection rate, epidemic pattern, and clinical features of respiratory syncytial virus (RSV) in hospitalized children with acute lower respiratory infection (ALRI). Methods Nasopharyngeal aspirates were collected from children with ALRI, aged < 2 years, who were hospitalized in Children's Hospital of Chongqing Medical University from June 2013 to May 2018. Multiplex PCR was used to detect 16 common respiratory viruses. The epidemiological characteristics of RSV were analyzed. Results A total of 2 066 hospitalized children with ALRI were enrolled. Among the children, 1 595 (77.20%) tested positive for virus and 826 (39.98%) tested positive for RSV [410(49.6%) positive for RSV-A, 414 (50.1%) positive for RSV-B, and 2 (0.2%) positive for both RSV-A and RSV-B]. RSV-B was the main subtype detected in 2013-2014 and 2016-2017, while RSV-A was the main subtype in 2014-2015 and 2017-2018, and these two subtypes were prevalent in 2015-2016. The highest detection rate of RSV was noted in winter. RSV + human rhinovirus was the most common combination of viruses and was detected in 123 children. These children were more likely to develop wheezing than those with single RSV detected (P=0.030). A total of 298 samples were detected with single RSV, 148 were detected with RSV mixed with other viruses, 389 were detected with other viruses, and 241 were detected negative for viruses. Compared with the other viruses and negative virus groups, the single RSV group had a significantly younger age and significantly higher incidence rates of dyspnea, respiratory failure, and severe lower respiratory tract infection (P < 0.0083). The RSV-A positive group had a significantly higher proportion of boys than the RSV-B positive group (P=0.004), but there were no significant differences in clinical manifestations between the two groups. Conclusions In Chongqing in 2013-2018, RSV-A and RSV-B not only can predominate alternately, but also can co-circulate during a season. RSV is the major viral pathogen of hospitalized children with ALRI and can cause severe lower respiratory tract infection. There are no differences in clinical manifestations between children with RSV-A infection and those with RSV-B infection, but boys are more susceptible to RSV-A infection.