本文關(guān)鍵詞：2012-2014年重慶兒童呼吸道病毒感染流行特征分析　出處：《中國人民解放軍軍事醫(yī)學(xué)科學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 呼吸道感染 鼻病毒 多瘤病毒 流行特征 兒童

【摘要】：目的了解重慶兒童急性病毒性呼吸道感染疾病的病原譜構(gòu)成,以及部分常見呼吸道病毒和新發(fā)現(xiàn)呼吸道病毒的流行情況和基因特征,從而為重慶乃至其它地區(qū)的兒童急性病毒性呼吸道感染的防控提供基礎(chǔ)資料和科學(xué)依據(jù)。內(nèi)容1.研究2012年6月到2014年5月兩年間重慶地區(qū)呼吸道感染患兒各種呼吸道病毒陽性檢出率、復(fù)合感染率、時間分布特征、年齡和性別分布情況、與呼吸道疾病的關(guān)系,以及住院患兒的臨床癥狀;2.研究2012年6月到2014年5月兩年間重慶地區(qū)呼吸道感染患兒鼻病毒的感染情況,并對鼻病毒陽性檢出病例進行基因分型,研究每種型別的陽性檢出率、復(fù)合感染率、時間分布特征、年齡和性別分布情況、臨床癥狀以及鼻病毒C型的基因特征。3.研究2012年6月到2014年5月兩年間重慶地區(qū)呼吸道感染兒童中WU多瘤病毒和KI多瘤病毒感染情況,從而對其進行流行病學(xué)研究和基因特征分析。對象研究標本來自重慶醫(yī)科大學(xué)附屬兒童醫(yī)院,時間為2012年6月到2014年5月,病例定義為具備急性感染表現(xiàn)和呼吸道臨床表現(xiàn)的住院兒童,所采集的樣本為鼻咽抽吸物。方法對于符合病例定義的患兒,采集其鼻咽抽吸物標本,采用核酸提取、逆轉(zhuǎn)錄、PCR、熒光定量PCR等方法對常見和新發(fā)現(xiàn)的呼吸道病毒,包括RSV、IFV、PIV、HAd V、HBo V、MPV、HEV/HRV、HCo V、WUPy V、KIPy V和SAFV進行檢測和基因分型,并對部分病毒進行PCR擴增和測序獲得其基因序列。采用相應(yīng)的統(tǒng)計分析方法和基因序列分析方法對各病毒進行流行病學(xué)研究和基因特征分析。結(jié)果1.呼吸道病毒感染監(jiān)測情況本研究共收集2012年6月至2014年5月因急性呼吸道感染而住院的兒童病例994份,呼吸道病毒陽性檢出率為76.46%。陽性檢出率最高的呼吸道病毒是RSV(295,29.68%),其余依次為PIV(260,26.16%)、HEV/HRV(187,18.81%)、IFV(110,11.07%)、WUPy V(107,10.76%)、HBo V(79,7.95%)、HAd V(39,3.92%)、MPV(29,2.92%)、HCo V(15,1.51%)、KIPy V(9,0.91%)和SAFV(6,0.60%)。病毒之間的復(fù)合感染率普遍較高,在46.15%~80.00%之間。RSV、IFV和WUPy V的季節(jié)性特征較明顯。其中RSV的檢出主要集中在秋冬季,而IFV和WUPy V的檢出在春夏季較多。HEV/HRV全年檢出率均較高。HEV/HRV和HBo V在男性患兒中的檢出率顯著高于女性患兒。大多數(shù)病毒在兒童中的檢出率隨著年齡的增大而降低,但IFV-A在2-5歲年齡組患兒的檢出率最高�？人允茿RTI患兒最主要的癥狀,其它主要癥狀依次為咳痰、發(fā)熱、腹瀉、呼吸困難和流涕。在ARTI患兒主要的四種診斷結(jié)果中,呼吸道病毒陽性檢出率由高到低依次為支氣管炎、哮喘、肺炎和上呼吸道感染。PIV、RSV和IFV為支氣管炎患兒所感染病毒病原前三位;哮喘、肺炎和上呼吸道感染的患病兒童所感染的病毒病原前三位均為RSV、PIV和HEV/HRV。2.鼻病毒本研究中共檢出HRV陽性107份,檢出率為10.76%,其中A型63例,B型8例,C型36例;相比于HRV-A和HRV-B,HRV-C引起較多的咳痰;三種型別之間診斷為重癥肺炎的差異具有統(tǒng)計學(xué)意義(P0.05)。三種型別均具有較高復(fù)合感染率,(44.44%~62.5%),RSV-B、PIV3和WUPy V是HRV-A和HRV-C復(fù)合感染率最高的三種病毒。HRV-C在重慶地區(qū)流行的亞型眾多,分布較為分散,排在前兩位的為C6和C38(各4株),另外有18個亞型均有檢出,2009~2012年為重慶地區(qū)優(yōu)勢流行株的HRV-C2,在本次研究中并未檢出;2009~2012年在重慶檢出的被暫時命名為新亞型的CQ4290,在本次研究中檢出3條序列與其基因相似度在92.15%-96.71%之間,提示這一新亞型可能已在重慶地區(qū)較為流行。3.WU多瘤病毒和KI多瘤病毒本次研究中,WUPy V的陽性檢出率為10.76%,在本研究所檢測的全部呼吸道病毒中位列第五。WUPy V感染多發(fā)生于春季(57,23.27%)和夏季(34,13.71%),秋冬季節(jié)較少,四季分布的差異具有統(tǒng)計學(xué)意義(P0.001);在2012年6-8月WUPy V檢出率出現(xiàn)小高峰,而在2013年4-6月檢出率顯著增高,達到頂峰(72.97%),提示這一時間可能出現(xiàn)過WUPy V感染的暴發(fā)。在107份WUPy V陽性樣本中,WUPy V單一感染病例為29(27.10%)例,與其它病毒復(fù)合感染78(72.90%)例,PIV3是與WUPy V復(fù)合感染例數(shù)最多的病毒,為28例。29例WUPy V單獨感染病例中,5例診斷為上呼吸道感染,哮喘和支氣管炎各2例,26例被診斷為肺炎,其中5例為重癥肺炎。KI多瘤病毒共檢出9例陽性,檢出率為0.91%;9份陽性病例中,KIPy V單一感染2例,與其它病毒復(fù)合感染7例,其中與WUPy V和HEV/HRV分別有4例復(fù)合感染。2例單一感染病例的診斷結(jié)果分別為肺炎和支氣管炎。本研究獲得WUPy V的VP2基因序列84條,系統(tǒng)發(fā)育分析表明84條序列共形成七個進化分支;獲得KIPy V的VP1基因序列8條,與各地的基因序列比較,僅蘭州株與本研究獲得序列有一個堿基的不同;兩種病毒基因序列與國內(nèi)外序列差異較小,相似度均在95%以上。結(jié)論1.各種呼吸道病毒感染的流行特征(1)呼吸道常見病毒是引起重慶地區(qū)兒童急性呼吸道感染的主要病原體。主要的呼吸道病毒檢出率排序前五位依次為RSV、PIV、HEV/HRV、IFV和WUPy V;(2)RSV-B成為重慶地區(qū)RSV流行的主導(dǎo)型別,RSV的A型和B型可能在當(dāng)?shù)爻尸F(xiàn)兩年為周期的交替流行;(3)WUPy V在2013年4-6月檢出率明顯增高,提示在這一時間段可能出現(xiàn)過WUPy V的暴發(fā)。2.鼻病毒(1)HRV是重要的上呼吸道感染的病原體,以A型和C型為主,近年來新發(fā)現(xiàn)的呼吸道病毒W(wǎng)UPy V排在HRV復(fù)合感染病毒的前列;(2)HRV-C在重慶地區(qū)的亞型分布較為分散,C6和C38亞型最多,這兩年與2009-2012年的優(yōu)勢流行株有所變化,本次研究檢出了2009-2012年重慶樣本中定義的新亞型。3.WU多瘤病毒和KI多瘤病毒(1)WUPy V在重慶地區(qū)檢出率較高,為10.76%;KIPy V檢出率為0.91%。熒光定量PCR方法檢測WUPy V與KIPy V靈敏性可能高于常規(guī)PCR方法;(2)單獨感染W(wǎng)UPy V和KIPy V的病例診斷結(jié)果包括肺炎、支氣管炎、上呼吸道感染甚至重癥肺炎,提示W(wǎng)UPy V和KIPy V可能是引起兒童呼吸道感染的病原體;(3)本研究獲得的WUPy V和KIPy V基因序列與國內(nèi)外序列均具有較高的相似度,本地區(qū)WUPy V和KIPy V的基因均較為穩(wěn)定和保守。
[Abstract]:Objective to understand the Chongqing disease in children with acute viral respiratory tract infection etiology, and some common respiratory viruses and found the prevalence and genetic characteristics of respiratory viruses, and provide a scientific basis for the prevention and control of Chongqing and other regions of the children with acute viral respiratory tract infection. 1. studies from June 2012 to May 2014 two years in Chongqing area respiratory tract infection in children with respiratory virus positive rate, combined infection rate, time distribution, age and gender distribution, the relationship with respiratory disease, and clinical symptoms in hospitalized children; infection of 2. studies from June 2012 to May 2014 two years in Chongqing area of respiratory rhinovirus infection in children, and the positive cases of nasal virus gene type of each type of positive rate, combined infection rate, time distribution Sign, age and gender distribution, June 2012.3. genotype study on clinical symptoms and nasal virus type C in the two years to May 2014 in Chongqing area of respiratory tract infection in children in the WU virus and KI virus infection, and characteristic analysis of the epidemiological studies and research object gene. Specimens from children's Hospital Affiliated to Medical University Of Chongqing. Time is June 2012 to May 2014, were defined as hospitalized children with acute respiratory tract infection and clinical manifestations, the collected samples for nasopharyngeal aspirates. Methods for the case definition were collected nasopharyngeal aspirates specimens, using nucleic acid extraction, reverse transcription, PCR, fluorescence quantitative PCR method of common and new discoveries the respiratory virus, including RSV, IFV, PIV, HAd, V, HBo, V, MPV, HEV/HRV, HCo V, WUPy V, KIPy V and SAFV detection and genotyping, and on the part of The virus was amplified by PCR and sequenced the gene sequence. The corresponding statistical analysis method and sequence analysis method for the analysis of virus epidemiological studies and genetic characteristics. Monitoring of this study collected from June 2012 to May 2014 due to acute respiratory tract infection in hospitalized children in 994 cases of 1. respiratory virus infection, respiratory virus positive rate 76.46%. positive rate of respiratory virus is the highest RSV (295,29.68%), followed by PIV (260,26.16%), HEV/HRV (187,18.81%), IFV (110,11.07%), WUPy V (107,10.76%), HBo V (79,7.95%), HAd V (39,3.92%), MPV (29,2.92%), HCo V (15,1.51%), KIPy V (9,0.91%) and SAFV (6,0.60%). The virus infection rate between the composite is generally high,.RSV between 46.15%~80.00%, IFV and WUPy V seasonal characteristics obviously. The RSV was mainly concentrated in the autumn and winter, and IFV and Detection of WUPy V in the spring and summer of more.HEV/HRV annual detection rates were higher in.HEV/HRV and HBo V in male children with the detection rate was significantly higher than that of female patients. The detection rate decreased with the increase of age and most of the virus in children, but the IFV-A in the 2-5 age group of children with high detection rate of the cough is the main symptom. With ARTI, the other are the main symptoms of cough, fever, diarrhea, dyspnea and runny nose. In four ARTI were the main diagnostic results in respiratory virus positive rate from high to low as bronchitis, asthma, pneumonia and upper respiratory tract infection of.PIV, RSV and IFV for bronchiolitis were infected by the virus before three; asthma, virus infection pneumonia and upper respiratory tract infection in children before three were RSV, PIV and HEV/HRV.2. were detected in this study of rhinovirus 107 were HRV positive, the positive rate was 10.76%. In 63 cases of type A, type B 8 cases, type C 36 cases; compared to HRV-A and HRV-B, HRV-C caused more sputum; with statistical significance between the three types of diagnostic difference of severe pneumonia (P0.05). Three types of composite has higher infection rate (44.44%~62.5%), RSV-B, PIV3 and WUPy V is a subtype of HRV-A and HRV-C combined infection rate of three kinds of virus.HRV-C the highest prevalence in Chongqing area is numerous, are widely distributed in the top two for the C6 and C38 (4 strains), another 18 subtypes were detected, 2009~2012 years in Chongqing strains HRV-C2, in this study was not detected; 2009~2012 in Chongqing was temporarily named a new subtype of CQ4290 in this study were 3 sequences and genetic similarity between 92.15%-96.71%, indicating that this subtype may have been more popular in the Chongqing area.3.WU virus and KI virus this time In the study, WUPy V positive rate was 10.76%, in this study detected all respiratory virus was fifth.WUPy V infections occur in spring and summer (57,23.27%) (34,13.71%), the autumn season is less, the difference was statistically significant seasonal distribution (P0.001); in 2012 6-8 month WUPy V detection rate appeared a small peak, and in 2013 4-6 month rate increased significantly and reached the peak (72.97%), indicating that this time there may have been an outbreak of WUPy V infection. In 107 WUPy V positive samples, WUPy V single infection cases were 29 (27.10%) cases, and other virus infection in 78 (72.90%) cases. PIV3 is the most WUPy and V composite virus infection cases, 28 cases of.29 patients with WUPy V infection cases, 5 cases were diagnosed as upper respiratory tract infection, asthma and bronchitis in 2 cases, 26 cases were diagnosed with pneumonia, including 5 cases of severe pneumonia.KI virus were detected in 9 patients with Yang , the detection rate was 0.91%; 9 positive cases, 2 cases of KIPy V single infection, and other virus infection in 7 cases, including WUPy and V and HEV/HRV respectively in 4 cases of diagnosis of complex cases with.2 infection in single infection cases were pneumonia and bronchitis. In this study VP2 gene sequence of WUPy V 84 a phylogenetic analysis showed that 84 sequences were divided into seven clades; VP1 gene sequence of KIPy V 8, compared with the gene sequence around, only Lanzhou strain and this study obtained one nucleotide sequence is different; two small virus gene sequences at home and abroad to sequence differences, the similarity was 95%. Conclusions the epidemiological characteristics of 1. kinds of respiratory viral infections (1) respiratory tract virus is mainly caused by the pathogen in children with acute respiratory tract infections in Chongqing area. The top five were RSV, PIV, HEV/HRV detection rate of respiratory viruses, IFV WUPy and V; (2) the dominant type of RSV-B RSV became popular in Chongqing, RSV A and B may be in the local popular show two years alternating cycle; (3) WUPy V in 2013 4-6 month rate significantly increased, suggesting that in this period of time may be WUPy V in nasal.2. (1) HRV virus is an important pathogen of upper respiratory tract infection, A type and C type, newly discovered respiratory virus WUPy V virus infection in HRV composite forefront; (2) HRV-C in the Chongqing area of the subtype distribution is more dispersed, C6 and C38 subtypes and most, this year 2009-2012 strains change, this study detected a new subtype of.3.WU defined 2009-2012 years in Chongqing sample polyoma virus and KI virus (1) WUPy V in the Chongqing area high detection rate was 10.76%; the detection rate of V KIPy 0.91%. fluorescent quantitative PCR method for detecting WUPy V and KIPy V the sensitivity can be Can be higher than the conventional PCR method; (2) cases of WUPy infection and KIPy diagnosis alone V V results including pneumonia, bronchitis, pneumonia and upper respiratory tract infection, suggesting that WUPy V and KIPy V may be the cause of children's respiratory tract infection pathogens; (3) the acquired WUPy V and KIPy V gene sequences at home and abroad sequences have high similarity, the local WUPy V and KIPy V genes were relatively stable and conservative.

【學(xué)位授予單位】：中國人民解放軍軍事醫(yī)學(xué)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R725.6

【參考文獻】

相關(guān)博士學(xué)位論文 前1條

1 盧慶彬;兒童急性呼吸道感染病毒流行特征與基因特征研究[D];山東大學(xué);2013年

，

本文編號：1362479