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目的了解呼吸道病毒混合感染所致急性下呼吸道感染(ALRTI)患儿的临床特征。方法 2007年10月至2011年9月,在首都医科大学附属北京儿童医院住院治疗的临床诊断为ALRTI的患儿1722例,在就诊当日或次日采集鼻咽吸取物1份,采用逆转录(RT)-PCR方法进行常见呼吸道病毒核酸检测,包括呼吸道合胞病毒(RSV)、鼻病毒(RV)、副流感病毒(PIV)1~4型、甲型及乙型流感病毒、腺病毒、肠道病毒、冠状病毒、偏肺病毒及博卡病毒。将单一RSV感染与RSV混合多种病毒感染患儿临床资料进行比较。结果 1722例患儿标本中,370例检出RSV病毒,总检出率21.5%。单一RSV感染206例,RSV与一种病毒混合感染124例,RSV与2种以上病毒混合感染40例。RSV与一种病毒混合感染的124例标本中,RSV/RV感染68例(54.8%),其次为RSV/PIV感染24例(19.3%)。双重病毒混合感染组与RSV单一病毒感染组比较,双重病毒混合感染组患儿住院时间更长(P<0.001)。多重病毒感染组与RSV单一病毒感染组相比,患儿发热比例更高(P=0.017)、发热持续时间更长(P=0.015)、住院天数延长(P<0.001)、并且在住院期间接受了更多的静脉激素治疗(P=0.005)。而在喘息症状、出现合并症(心力衰竭、呼吸衰竭、肝功损害、心肌损害、腹泻)方面差异无统计学意义。在氧疗、呼吸支持治疗及使用支气管扩张剂方面差异亦无统计学意义。结论与单一RSV感染组相比,RSV合并多重病毒感染患儿发热比例更高、发热持续时间及住院天数更长,且住院期间接受了更多的静脉激素治疗。提示多病毒混合感染可能影响患儿临床进程,RSV感染时应重视混合感染。
Objective To understand the clinical features of children with acute lower respiratory tract infection (ALRTI) caused by respiratory virus mixed infection. Methods From October 2007 to September 2011, 1722 children with ALRTI were enrolled in Beijing Children’s Hospital Affiliated to Capital Medical University. Nasopharyngeal aspirates were collected on the day of treatment or on the following day. Reverse transcription RT) -PCR method for detection of common respiratory virus nucleic acids, including respiratory syncytial virus (RSV), rhinovirus (RV), parainfluenza virus (PIV) 1-4, influenza A and B, adenovirus Road virus, Coronavirus, Metapneumovirus and Boca virus. A single RSV infection and RSV mixed multiple viral infection in children with clinical data were compared. Results Among 1722 children, 370 cases were detected RSV virus, the total detection rate was 21.5%. A single RSV infection in 206 cases, RSV mixed with a virus in 124 cases, RSV mixed with two or more viruses in 40 cases. Of the 124 specimens mixed with one virus, RSV / RV infections were 68 (54.8%), followed by 24 (19.3%) with RSV / PIV infections. Compared with the RSV single-virus-infected group, the double-virus mixed infection group had longer hospital stay (P <0.001). Children with multiple viral infections had a higher rate of fever (P = 0.017), longer duration of fever (P = 0.015), longer hospital stay (P <0.001), and higher rates of hospitalization during hospitalization compared with RSV single-virus infection More intravenous hormone therapy (P = 0.005). There were no significant differences in wheezing symptoms and comorbidities (heart failure, respiratory failure, liver damage, myocardial damage, diarrhea). There was also no significant difference in oxygen therapy, respiratory support therapy and the use of bronchodilators. Conclusions Compared with a single RSV infection group, children with RSV and multiple viral infections have a higher rate of fever, longer duration of fever and length of stay, and more intravenous hormone therapy during hospitalization. Prompt multi-virus mixed infection may affect the clinical course of children, RSV infection should pay attention to mixed infection.