2012-2014年重庆儿童呼吸道病毒感染流行特征分析

发布时间：2018-01-01 02:13

本文关键词：2012-2014年重庆儿童呼吸道病毒感染流行特征分析　出处：《中国人民解放军军事医学科学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的了解重庆儿童急性病毒性呼吸道感染疾病的病原谱构成,以及部分常见呼吸道病毒和新发现呼吸道病毒的流行情况和基因特征,从而为重庆乃至其它地区的儿童急性病毒性呼吸道感染的防控提供基础资料和科学依据。内容1.研究2012年6月到2014年5月两年间重庆地区呼吸道感染患儿各种呼吸道病毒阳性检出率、复合感染率、时间分布特征、年龄和性别分布情况、与呼吸道疾病的关系,以及住院患儿的临床症状;2.研究2012年6月到2014年5月两年间重庆地区呼吸道感染患儿鼻病毒的感染情况,并对鼻病毒阳性检出病例进行基因分型,研究每种型别的阳性检出率、复合感染率、时间分布特征、年龄和性别分布情况、临床症状以及鼻病毒C型的基因特征。3.研究2012年6月到2014年5月两年间重庆地区呼吸道感染儿童中WU多瘤病毒和KI多瘤病毒感染情况,从而对其进行流行病学研究和基因特征分析。对象研究标本来自重庆医科大学附属儿童医院,时间为2012年6月到2014年5月,病例定义为具备急性感染表现和呼吸道临床表现的住院儿童,所采集的样本为鼻咽抽吸物。方法对于符合病例定义的患儿,采集其鼻咽抽吸物标本,采用核酸提取、逆转录、PCR、荧光定量PCR等方法对常见和新发现的呼吸道病毒,包括RSV、IFV、PIV、HAd V、HBo V、MPV、HEV/HRV、HCo V、WUPy V、KIPy V和SAFV进行检测和基因分型,并对部分病毒进行PCR扩增和测序获得其基因序列。采用相应的统计分析方法和基因序列分析方法对各病毒进行流行病学研究和基因特征分析。结果1.呼吸道病毒感染监测情况本研究共收集2012年6月至2014年5月因急性呼吸道感染而住院的儿童病例994份,呼吸道病毒阳性检出率为76.46%。阳性检出率最高的呼吸道病毒是RSV(295,29.68%),其余依次为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%)。病毒之间的复合感染率普遍较高,在46.15%~80.00%之间。RSV、IFV和WUPy V的季节性特征较明显。其中RSV的检出主要集中在秋冬季,而IFV和WUPy V的检出在春夏季较多。HEV/HRV全年检出率均较高。HEV/HRV和HBo V在男性患儿中的检出率显著高于女性患儿。大多数病毒在儿童中的检出率随着年龄的增大而降低,但IFV-A在2-5岁年龄组患儿的检出率最高。咳嗽是ARTI患儿最主要的症状,其它主要症状依次为咳痰、发热、腹泻、呼吸困难和流涕。在ARTI患儿主要的四种诊断结果中,呼吸道病毒阳性检出率由高到低依次为支气管炎、哮喘、肺炎和上呼吸道感染。PIV、RSV和IFV为支气管炎患儿所感染病毒病原前三位;哮喘、肺炎和上呼吸道感染的患病儿童所感染的病毒病原前三位均为RSV、PIV和HEV/HRV。2.鼻病毒本研究中共检出HRV阳性107份,检出率为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引起较多的咳痰;三种型别之间诊断为重症肺炎的差异具有统计学意义(P0.05)。三种型别均具有较高复合感染率,(44.44%~62.5%),RSV-B、PIV3和WUPy V是HRV-A和HRV-C复合感染率最高的三种病毒。HRV-C在重庆地区流行的亚型众多,分布较为分散,排在前两位的为C6和C38(各4株),另外有18个亚型均有检出,2009~2012年为重庆地区优势流行株的HRV-C2,在本次研究中并未检出;2009~2012年在重庆检出的被暂时命名为新亚型的CQ4290,在本次研究中检出3条序列与其基因相似度在92.15%-96.71%之间,提示这一新亚型可能已在重庆地区较为流行。3.WU多瘤病毒和KI多瘤病毒本次研究中,WUPy V的阳性检出率为10.76%,在本研究所检测的全部呼吸道病毒中位列第五。WUPy V感染多发生于春季(57,23.27%)和夏季(34,13.71%),秋冬季节较少,四季分布的差异具有统计学意义(P0.001);在2012年6-8月WUPy V检出率出现小高峰,而在2013年4-6月检出率显著增高,达到顶峰(72.97%),提示这一时间可能出现过WUPy V感染的暴发。在107份WUPy V阳性样本中,WUPy V单一感染病例为29(27.10%)例,与其它病毒复合感染78(72.90%)例,PIV3是与WUPy V复合感染例数最多的病毒,为28例。29例WUPy V单独感染病例中,5例诊断为上呼吸道感染,哮喘和支气管炎各2例,26例被诊断为肺炎,其中5例为重症肺炎。KI多瘤病毒共检出9例阳性,检出率为0.91%;9份阳性病例中,KIPy V单一感染2例,与其它病毒复合感染7例,其中与WUPy V和HEV/HRV分别有4例复合感染。2例单一感染病例的诊断结果分别为肺炎和支气管炎。本研究获得WUPy V的VP2基因序列84条,系统发育分析表明84条序列共形成七个进化分支;获得KIPy V的VP1基因序列8条,与各地的基因序列比较,仅兰州株与本研究获得序列有一个碱基的不同;两种病毒基因序列与国内外序列差异较小,相似度均在95%以上。结论1.各种呼吸道病毒感染的流行特征(1)呼吸道常见病毒是引起重庆地区儿童急性呼吸道感染的主要病原体。主要的呼吸道病毒检出率排序前五位依次为RSV、PIV、HEV/HRV、IFV和WUPy V;(2)RSV-B成为重庆地区RSV流行的主导型别,RSV的A型和B型可能在当地呈现两年为周期的交替流行;(3)WUPy V在2013年4-6月检出率明显增高,提示在这一时间段可能出现过WUPy V的暴发。2.鼻病毒(1)HRV是重要的上呼吸道感染的病原体,以A型和C型为主,近年来新发现的呼吸道病毒WUPy V排在HRV复合感染病毒的前列;(2)HRV-C在重庆地区的亚型分布较为分散,C6和C38亚型最多,这两年与2009-2012年的优势流行株有所变化,本次研究检出了2009-2012年重庆样本中定义的新亚型。3.WU多瘤病毒和KI多瘤病毒(1)WUPy V在重庆地区检出率较高,为10.76%;KIPy V检出率为0.91%。荧光定量PCR方法检测WUPy V与KIPy V灵敏性可能高于常规PCR方法;(2)单独感染WUPy V和KIPy V的病例诊断结果包括肺炎、支气管炎、上呼吸道感染甚至重症肺炎,提示WUPy V和KIPy V可能是引起儿童呼吸道感染的病原体;(3)本研究获得的WUPy V和KIPy V基因序列与国内外序列均具有较高的相似度,本地区WUPy V和KIPy V的基因均较为稳定和保守。
[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.

【学位授予单位】：中国人民解放军军事医学科学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R725.6

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