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目的了解2009年-2012年上海地区儿童流行的甲型H3N2流感病毒对金刚烷胺和奥司他韦(达菲)的耐药情况。方法收集2009年6月-2012年5月期间复旦大学儿科医院、31家上海市流感哨点医院门诊类流感患儿的鼻咽拭子标本,所有的标本抽提核酸后采用荧光RT-PCR检测甲型H3N2流感病毒。选取部分检测阳性标本行普通RTPCR进一步扩增H3N2流感病毒基质蛋白2(Matrix protein,M2)和神经氨酸酶(Neuraminidase,NA)的部分基因片段并测序,通过相关耐药位点的分子标志来评价抗病毒耐药。结果在17 312份标本中,1 148份(6.63%)检测为H3N2亚型流感病毒阳性。测序的76株甲型H3N2病毒均携带介导对金刚烷胺耐药的S31N突变标志,未发现甲型H3N2病毒株携带对奥司他韦耐药的分子标志。结论目前上海地区儿童中流行的甲型H3N2流感病毒对金刚烷胺普遍耐药,金刚烷胺不应该推荐治疗儿童流感。奥司他韦是防治甲型H3N2流感病毒敏感的药物。
Objective To understand the resistance of amantadine and oseltamivir (Tamiflu) to influenza A (H3N2) virus in children in Shanghai during 2009-2012. Methods Nasopharyngeal swab specimens from children with influenza in outpatient department of Fudan University in Shanghai were collected from June 2009 to May 2012 in Fudan University Pediatric Hospital. All samples were extracted by nucleic acid and detected by RT-PCR Influenza A H3N2 virus. A part of positive samples were selected to further amplify part of the gene fragments of Matrix protein (M2) and neuraminidase (NA) of H3N2 influenza virus by routine RTPCR and sequenced. Through molecular markers of related drug resistance sites Evaluation of antiviral resistance. Results Of 17 312 specimens, 1 148 (6.63%) were positive for H3N2 influenza virus. All of the 76 strains of H3N2 viruses sequenced carried the S31N mutation markers that were resistant to amantadine. No molecular markers of resistance to oseltamivir were found in the H3N2 strain. Conclusions Influenza A (H3N2) influenza virus prevalence among children in Shanghai is generally resistant to amantadine, and amantadine should not be recommended for the treatment of childhood flu. Oseltamivir is a sensitive drug for the prevention and treatment of influenza A (H3N2) virus.