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中国循证儿科杂志

中国循证儿科杂志 ›› 2021, Vol. 16 ›› Issue (4): 296-300.

• 论著 • 上一篇    下一篇

新型冠状病毒肺炎疫情前后急性呼吸道感染儿童支原体、 衣原体和常见病毒谱分析

罗小娟1蔡德丰1任振敏1刘永秋1刘景1黄丽兰1刘小兰2曹科1陈运生1   

  1. 深圳市儿童医院深圳，518038；1 检验科，2 呼吸科
  • 收稿日期:2021-05-06 修回日期:2021-09-04 出版日期:2021-08-25 发布日期:2021-08-25
  • 通讯作者: 曹科

Analysis of mycoplasma, chlamydia and common virus spectrum of children with acute respiratory tract infection before and after COVID-19 epidemic :A cross-sectional survey

LUO Xiaojuan1, CAI Defeng1, REN Zhenmin1, LIU Yongqiu1,LIU Jing1,HUANG Lilan1, LIU Xiaolan2,CAO Ke1,CHEN Yunsheng1   

  1. Shenzhen Children's Hospital, Shenzhen 518038, China, 1 Department of Laboratory, 2 Department of Respiration
  • Received:2021-05-06 Revised:2021-09-04 Online:2021-08-25 Published:2021-08-25
  • Contact: CAO Ke

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摘要： 背景：目前尚不清楚新型冠状病毒肺炎（COVID-19）流行暴发以来急性呼吸道感染（ARTI）的病原谱是否发生了重要变化。 目的：基于深圳地区COVID-19疫情前后ARTI住院患儿的病原学特征和病原谱的变化，为本地区ARTI的临床诊治及防控提供依据。 设计：横断面调查。 方法：纳入深圳市儿童医院2019年9月2日至2021年2月28日非新生儿临床诊断ARTI住院后首次送检的咽拭子标本。采用多重PCR与毛细电泳联用技术检测13种常见病原体。以2020年3月至2021年2月的数据进行不同季节的ARTI病原谱比较，春季为3~5月，夏季为~8月，秋季为~11月，冬季为12月至次年2月。以2019年9月2日至2020年1月24日的数据作为COVID-19疫情前、2020年9月2日至2021年1月24日的数据作为COVID-19疫情后进行比较。 主要结局指标支原体、衣原体和常见病毒谱。 结果：12 022例ARTI住院患儿的咽拭子标本进入分析，病原体阳性（至少检出1种）7 589例（ 63.13%），其中鼻病毒检出率最高（24.83%），其次是呼吸道合胞病毒（14.12%）、副流感病毒（8.33%）、偏肺病毒（7.01%）、肺炎支原体（5.37%）。混合感染（检出≥2种病原体）1 329例（11.05%），以鼻病毒+肺炎支原体最常见。①秋季病原体检出率最高（66.99%，1 924/2 874），以呼吸道合胞病毒（25.89%）和鼻病毒（24.01%）最高；春季病原体检出率最低（16.20%，132/815），以鼻病毒（5.03%）和肺炎支原体（3.80%）最高。②6月龄至6岁患儿病原体检出率高于总体检出率，随年龄增长，呼吸道合胞病毒和副流感病毒检出率呈下降趋势，肺炎支原体检出率呈上升趋势。不同性别患儿病原体检出率差异无统计学意义。③ COVID-19疫情前病原体检出率为78.57%（2 592/3 299），以鼻病毒（36.37%）、肺炎支原体（15.40%）、呼吸道合胞病毒（10.03%）、腺病毒（9.03%）为主，混合感染764例（23.16%）；疫情后同期病原体检出率为65.89%（3 500/5 312），以鼻病毒（23.78%）、呼吸道合胞病毒（14.74%）、偏肺病毒（12.65%）、副流感病毒（12.12%）为主，混合感染459例（8.64%）。 结论：ＣＯＶＩＤ-１９ 疫情后 ＡＲＴＩ 病原谱发生了明显变化。 偏肺病毒、副流感病毒、呼吸道合胞病毒、博卡病毒检出率明显升高；混合感染、支原体、衣原体、甲型流感 Ｈ１Ｎ１ 病毒、季节性 Ｈ３Ｎ２ 病毒、乙型流感病毒、鼻病毒、腺病毒检出率明显下降。

关键词: 急性呼吸道感染, 儿童, 病原体, COVID-19, 深圳

Abstract: Background: It is unknown whether the pathogen spectrum of acute respiratory infection (ARTI) have changed significantly since the outbreak of COVID-19. Objective: To analyze the etiological characteristics of hospitalized children with ARTI before and after COVID-19 epidemic in Shenzhen, in order to provide reference for the clinical diagnosis, treatment and prevention of ARTI. Design: Cross-sectional survey. Methods: Pharyngeal swab samples submitted for the first time excluding those of neonates after hospitalization for clinical diagnosis of ARTI in Shenzhen Children's Hospital from September 2, 2019 to February 28, 2021 were included. Multiple PCR and capillary electrophoresis were used to detect 13 kinds of common pathogens in nasopharyngeal secretion samples. Based on the data from March 2020 to February 2021, the pathogen profiles of ARTI in different seasons were compared, from March to May in spring, from June to August in summer, from September to November in autumn, and from December to February of the next year in winter. Data from September 2,2019 to January 24,2020 were used as pre-COVID-19 data and from September 2, 2020 to January 24, 2021 as post-COVID-19 data for comparison. Main outcome measures: Mycoplasma, chlamydia and common virus spectrum of ARTI. Results: Among 12,022 cases of nasopharyngeal secretion, pathogens were detected in 7,589 cases with the detection rate of 63.13%. The highest detection rate was for human rhinovirus (HRV,24.83%), followed by respiratory syncytial virus (RSV,14.12%), human parainfluenza virus (HPIV,8.33%), human metapneumovirus (HMPV,7.01%), and mycoplasma pneumoniae (MP,5.37%).There were 1,329 cases of mixed infection with two or more pathogens was detected simultaneously, accounting for 11.05% (1,329/12,022). HRV and MP were the most common combination. The highest detection rate was 66.99% (1,924/2,874) in autumn, with RSV ranked first in the list (25.89%), followed by HRV (24.01%).The lowest detection rate was 16.20% (132/815) in spring, with HRV ranked first in the list (5.03%), followed by MP (3.80%).The detection rate of pathogens in children aged 6 months to 6 years was higher than the overall average.With the increase of age, the detection rate of RSV and HPIV decreased significantly, while the detection rate of MP increased. There was no significant difference in the detection rate between male and female patients (P>0.05). Before COVID-19 epidemic, the detection rate of pathogens was 78.57%（2,592/3,299）, with HRV(36.37%), MP (15.40%), RSV(10.03%), adenovirus (9.03%) as the main pathogens. A total of 764 mixed infection cases were found (23.16%). After COVID-19 epidemic, the detection rate of pathogens during the same period was 65.89%（3,500/5,312）, with HRV (23.78%), RSV (14.74%), HMPV(12.65%) and HPIV (12.12%) as the main pathogens, and there were 459 cases (8.64%) of mixed infections. Conclusion: The pathogen spectrum of ARTI had changed significantly after the outbreak of COVID-19. The detection rate of HMPV,HPIV,RSV,Bocavirus had increased significantly. However, the detection rate of MP, chlamydia, influenza A,H1N1, H3N2, influenza B, HRV, adenovirus, mixed infections decreased significantly.

Key words: Acute respiratory infection, Children, Pathogens, COVID-19, Shenzhen