【摘要】：目的： 了解重慶地區(qū)呼吸道感染患兒甲型流感(Influenza A virus, IVA)與新型甲型H1N1流感病毒(Swine-origin influenza A H1N1virus,S-OIVs)流行情況、臨床特征,并探討IVA感染后發(fā)展為重癥肺炎的危險(xiǎn)因素。 方法： 收集重慶醫(yī)科大學(xué)附屬兒童醫(yī)院呼吸一病房住院的呼吸道感染患兒的鼻咽抽吸物1074例,時(shí)間從2009年6月至2011年5月。采用Real-Time RT-PCR技術(shù)定性檢測標(biāo)本中甲型流感及新型甲型H1N1流感病毒RNA, S-OIVs陽性標(biāo)本擴(kuò)增產(chǎn)物、測序,結(jié)果與Genebank中序列進(jìn)行比較以明確,并結(jié)合臨床資料進(jìn)行分析。使用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)分析。 結(jié)果： 1. IVA/S-OIVs陽性檢出率：標(biāo)本總數(shù)1074份,檢出IVA陽性105例(包含S-OIVs陽性15例),陽性率9.8%,檢出S-OIVs陽性15例,陽性率1.4%。 2.IVA/S-OIVs感染流行病學(xué)特點(diǎn)：IVA陽性105例,男性72例,女性33例,男：女=2.2：1；年齡1～135月,≤5歲檢出陽性97例(92.4%),其中≤2歲檢出陽性81例(77.1%),以春、夏季節(jié)感染為主。15例S-OIVs感染患兒中男性12例,女性3例,男：女=4：1；年齡1～63月,≤5歲陽性檢出13例(86.7%),其中≤2歲陽性檢出12例(80%),以夏季感染為主。 3.IVA/S-OIVs感染臨床特點(diǎn)：IVA/S-OIVs感染主要引起肺炎。IVA/S-OIVs感染患兒大部分伴有發(fā)熱、咳嗽、咳痰癥狀,1/3伴有喘息,肺部體征以濕羅音居多。IVA/S-OIVs感染后外周血白細(xì)胞計(jì)數(shù)及C反應(yīng)蛋白多不升高,淋巴細(xì)胞分類為主。IVA混合感染其他常見呼吸道病毒48份(45.796)；S-OIVs混合感染其他常見呼吸道病毒9份(60.0%)。兩者最常見的混合感染均是PIV3。 4.IVA感染后發(fā)展為重癥肺炎的相關(guān)危險(xiǎn)因素：重癥肺炎15例,男性9例,女性6例。病毒混合感染(P=0.027;OR=3.939;OR95%CI,1.164～13.329)、肺炎克雷伯氏菌痰培養(yǎng)(+)(P=0.023；OR=7.250; OR95%CI,1.311～40.098)或合并先天性心臟病(P=0.010:OR=8.533; OR95%CI,1.658～43.929)是IVA感染后引起重癥肺炎的相關(guān)危險(xiǎn)因素。 結(jié)論： 1.重慶地區(qū)呼吸道感染住院患兒IVA感染率為9.8%,S-OIVs感染率為1.4%。2歲以下兒童為主要易感人群,夏、春季為流行高峰季節(jié)。 2. IVA/S-OIVs感染后臨床表現(xiàn)無明顯特異性。IVA混合其他常見呼吸道病毒感染率為45.7%,S-OIVs混合其他常見呼吸道病毒感染率為60.0%。PIV3為兩者混合感染最常見病毒。 3.混合呼吸道其他常見病毒感染、肺炎克雷伯氏菌痰培養(yǎng)(+)或合并先天性心臟病是IVA感染后發(fā)展為重癥肺炎的相關(guān)危險(xiǎn)因素。
[Abstract]:Objective: to investigate the prevalence and clinical characteristics of influenza A (Influenza A virus, IVA) and new type A H1N1 influenza virus (Swine-origin influenza A H1 N 1 virus S OIVs) in children with respiratory tract infection in Chongqing, and to explore the risk factors for the development of severe pneumonia after IVA infection. Methods: from June 2009 to May 2011, 1074 cases of nasopharynx aspiration were collected from the respiratory ward of the Children's Hospital affiliated to Chongqing Medical University. Real-Time RT-PCR technique was used to qualitatively detect the amplification products of RNA, S-OIVs positive samples of influenza A and new type A H1N1 influenza virus. The results were compared with those in Genebank, and the results were analyzed in combination with clinical data. Use SPSS17.0 software for statistical analysis. Results: 1. The positive rate of IVA/S-OIVs: there were 1074 samples, 105 cases were positive for IVA (including 15 cases of S-OIVs), the positive rate was 9.8, the positive rate was S-OIVs in 15 cases, the positive rate was 1.40.Epidemiological characteristics of 2.IVA/S-OIVs infection, including 72 cases of male and 33 cases of female, were positive in 10 5 cases of 2.IVA/S-OIVs infection. Male: female: 2.2: 1, age 1 ~ 135 months, 97 cases (92.4%) were positive in 鈮，

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