Abstract:

Objective    To investigate the clinical relevance of multiple viral infections in children with acute lower respiratory disease. Methods    A total of 1722 children with clinical diagnosis of lower respiratory tract infection （ALRTI） during the period of October 2007 to September 2011 were involved in our study. One nasopharyngeal aspirate specimen was collected from each patient. （RT） PCRs were performed to detect common respiratory tract viruses including respiratory syncytial virus （RSV） ， rhinovirus （RV） ， influenza virus type A and B， parainfluenza virus （PIV） type 1-4， adenovirus ，enterovirus， human coronavirus， human metapneumonia virus and human bocavirus. Results    Totally 206 children had single RSV infection， 124 children had dual infections （RSV co-infected with an additional virus） and 40 children had multiple infections along with a RSV infection. Out of the 124 patients， 68（54.8%） were co-infected with RV， 24 with PIV. There was a statistically significant difference between the dual viral infections group and the RSV-infected group in hospital stay（P＜0.001）. Compared to patients in the single RSV infected group， patients in the multiple viral infection group had significantly more frequency in fever （P＝0.017）， duration of fever longer（P＝0.015）， hospital stay also longer（P＜0.001），and they received more intravenous steroid therapy during hospitalization（P＝0.005）. There was no significant difference in oxygen therapy， respiratory support and use of bronchodilators. Conclusion    Multiple viral infections are linked to more frequency in fever， longer fever days， longer hospital stay， and more frequent use of intravenous steroid therapy during hospitalization. Mixed respiratory virus infection may affect the patient's disease severity and prognosis.

Key words: respiratory viruses, respiratory syncytial virus, mixed infections

摘要：

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。

关键词: 呼吸道病毒, 呼吸道合胞病毒, 混合感染