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中国循证儿科杂志

中国循证儿科杂志 ›› 2023, Vol. 18 ›› Issue (2): 114-118.DOI: 10.3969/j.issn.1673-5501.2023.02.007

• 论著 • 上一篇    下一篇

新生儿内科患儿入院时咽拭子肠道病毒核酸检测的横断面研究

徐海冬1,陈祥鹏2,3,王红1,李奇2,史明睿1,覃菲1,谢正德2,3,黑明燕1   

  1. 1 国家儿童医学中心 首都医科大学附属北京儿童医院新生儿中心北京，100045；2 北京市儿科研究所感染与病毒研究室北京，100045；3 中国医学科学院儿童危重感染诊治创新单元北京，100045

  • 收稿日期:2022-09-07 修回日期:2023-03-09 出版日期:2023-04-25 发布日期:2023-05-19
  • 通讯作者: 黑明燕

Enterovirus nucleic acid detection from pharyngeal swabs collected at admission of neonates hospitalized in neonatal medical ward: A cross-sectional study

XU Haidong1, CHEN Xiangpeng2,3, WANG Hong1, LI Qi2, SHI Mingrui1, QIN Fei1, XIE Zhengde2,3, HEI Mingyan1   

  1. 1 Department of Neonatology, Neonatal Center, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China;2 Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing 100045, China;3 Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, Beijing 100045, China
  • Received:2022-09-07 Revised:2023-03-09 Online:2023-04-25 Published:2023-05-19
  • Contact: HEI Mingyan, email: heimingyan@bch.com.cn

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摘要： 背景：肠道病毒（EV）是导致新生儿感染的常见病原体之一，了解住院新生儿EV核酸检测的阳性率及疾病分布情况有助于制定合理的治疗方案。 目的：探讨新生儿内科住院患儿入院时肠道病毒（EV）咽拭子核酸检测的阳性率及疾病分布状况。 设计：横断面研究。 方法:对2020年10月至2021年9月在首都医科大学附属北京儿童医院新生儿内科住院的患儿，于入院当天采集咽拭子，采用CA16、EV71、EV通用型核酸三重实时荧光PCR检测试剂盒进行EV核酸检测。计算EV核酸检测阳性率，统计疾病分布情况，并比较EV阳性组与阴性组新生儿的临床表现和实验室指标差异。 主要结局指标:住院新生儿EV核酸检测的阳性率及疾病分布情况。 结果:①共纳入1 095例新生儿（占同期住院新生儿的91.2%），其中男婴605例（55.3%），足月儿976例（89.1%），入院中位日龄为11（4，19）d，第一入院诊断的前3顺位为新生儿病理性黄疸、新生儿肺炎、新生儿感染，住院中位时间为8（6，12）d。②EV核酸检测阳性检出率为9.1‰（10/1 095），感染性疾病患儿中EV核酸阳性检出率为18.6‰（9/483）。以呼吸道症状（5例）、黄疸（3例）和消化道症状（2例）为首发症状。10例均治愈或好转出院。③EV阳性组和阴性组在性别、出生体重、出生胎龄、是否早产、分娩方式、喂养方式、母亲存在围生期感染高危因素、母妊娠期糖尿病、发病日龄、住院时间、住院费用等方面差异均无统计学意义（P>0.05）。EV阳性组（60.0%）在发病前感染接触史的发生率高于EV阴性组（7.0%）；EV阳性组中枢神经系统感染（20.0%）高于EV阴性组（3.1%）；差异均有统计学意义。EV阳性组感染性疾病患儿比例（90.0%）高于阴性（43.7%）但差异无统计学意义；发热、病理性黄疸、呼吸道症状、消化道症状、神经系统症状的发生率在两组差异均无统计学意义（P＞0.05）。④EV阳性组和阴性组血WBC总数、Hb、PLT减少发生率、心肌酶和ALT升高发生率、血清总胆红素值、白蛋白、血肌酐及血尿素氮的比较差异均无统计学意义（P＞0.05）。 结论:新生儿内科患儿入院时的EV咽拭子核酸检测阳性率为9.1‰，临床表现和实验室常规检测结果无特异性改变；家庭成员传播可能是新生儿咽拭子EV核酸检测阳性的主要原因；EV核酸检测阳性患儿发生中枢神经系统感染的风险较高。

关键词: 肠道病毒感染, 临床特征, 新生儿

Abstract: Background:Enterovirus (EV) is one of the common pathogens that cause neonatal infection. Understanding the positive rate of EV nucleic acid detection and the disease distribution of hospitalized newborns will facilitate the development of rational therapeutic strategies. Objective:To investigate the positive rate of enterovirus nucleic acid swabs in hospitalized neonates and its distribution in diseases. Design:A crosssectional study. Methods:For patients hospitalized in neonatal medical ward at Beijing Children′s Hospital from October 1, 2020 to September 30, 2021,the throat swabs were taken on the day of admission. Realtime PCR was used to detected general enterovirus (EV)EV71/CA16(Coxsackievirus A16). The positive rate of EV nucleic acid test and its distribution in disease was calculated. Clinical manifestations and laboratory tests between the EV positive group and the negative group were compared. Main outcome measures:Positive rate of EV nucleic acid detection and disease distribution in hospitalized neonates. Results:A total of 1,095 neonates (accounting for 91.2% of the hospitalized patients during the same period) were enrolled, including 605 males (55.3%) and 976 term infants (89.1%). The median age of admission was 11 (419) days and the median hospital stay was 8 (612) days. The first three orders of admission diagnosis were neonatal hyperbilirubinemia, neonatal pneumonia, and neonatal septicemia. The positive rate of EV nucleic acid test was 9.1‰ (10/1095). The positive rate of EV nucleic acid in infectious diseases was (9/483, 18.6‰). Among them, 5 cases (50%), 3 cases (30%) and 2 cases (20%) were presented with respiratory symptoms, jaundice and gastrointestinal symptoms as the first symptoms, respectively. Ten children were cured or improved and discharged. There were no statistically significant differences between children with positive and negative EV nucleic acid tests in gender, birth weight, gestational age, preterm delivery, delivery mode, feeding mode, maternal risk factors of perinatal infection, maternal gestational diabetes, age of onset, length of hospital stay and hospitalization cost (P>0.05). The incidence of contact with family members with symptomatic infection before onset was 60% in children with positive EV nucleic acid test, higher than 7% in children with negative EV test, and the difference was statistically significant (P<0.001). The proportion of central nervous system infection in children with positive and negative EV nucleic acid test was 20% and 3.1%, respectively, and the difference was statistically significant (P<0.05), but there was no significant difference in the incidence of fever, pathological jaundice, respiratory symptoms, digestive symptoms and nervous system symptoms (P>0.05). The proportion of children with infectious disease was 90% in EV positive children, higher than 43.7% in EV negative children, but there was no statistical significance. There was no statistical significance in the total number of white blood cells, incidence of hemoglobin, thrombocytopenia, incidence of myocardial enzyme and glutamicpyruvic transaminase, serum total bilirubin value, albumin, serum creatinine and blood urea nitrogen in the positive and negative children with EV nucleic acid test (P>0.05). Conclusions:The positive rate of nucleic acid test of EV throat swabs was 9.1‰ at admission, and there was no specific change in clinical manifestations and laboratory routine test results. Transmission from family members may be the main cause of positive EV nucleic acid test in neonates. Children with positive EV nucleic acid test have a higher risk of central nervous system infection.

Key words: Enterovirus infection, Clinical features, Infant