临床儿科杂志 ›› 2018, Vol. 36 ›› Issue (11): 862-.doi: 10.3969/j.issn.1000-3606.2018.11.015

• 综合报道 • 上一篇    下一篇

246 例支气管哮喘急性发作住院患儿呼吸道病原学及 临床特征分析

张瑶, 任洛, 高钰, 王鹂鹂, 李慧, 余漪漪, 罗征秀, 刘恩梅, 谢晓虹   

  1. 重庆医科大学附属儿童医院呼吸科 儿童发育疾病研究教育部重点实验室 儿童发育重大疾病国家 国际科技合作基地 儿科学重庆市重点实验室(重庆 400014)
  • 收稿日期:2018-11-15 出版日期:2018-11-15 发布日期:2018-11-15
  • 通讯作者: 谢晓虹 E-mail:68621472@qq.com
  • 基金资助:
    国家科技重大专项“传染病监测技术平台”资助项目(No. 2013ZX10004202-002,No.2017ZX10103010-003)

Analysis of respiratory etiology and clinical features in 246 hospitalized children with acute asthma exacerbation in Chongqing

 ZHANG Yao, REN Luo, GAO Yu, WANG Lili, LI Hui, YU Yiyi, LUO Zhengxiu, LIU Enmei, XIE Xiaohong   

  1. Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China
  • Received:2018-11-15 Online:2018-11-15 Published:2018-11-15

摘要: 目的 分析2009—2016年重庆地区6岁以下支气管哮喘急性发作住院患儿的呼吸道病原检出及临床特征。 方法 收集2009年6月到2016年12月住院诊断为支气管哮喘急性发作的246例<6岁患儿的鼻咽抽吸物(NPA),每例患 儿只收集1份标本。采用PCR检测呼吸道病毒,同时进行痰细菌培养及支原体PCR检测。结果 入组患儿<3岁154例, 3~5岁92例。轻度发作189例,重度发作57例。NPA病毒检出阳性率为78.5% (193/246),细菌培养阳性率为39.4% (97/246), 支原体检测阳性率为6.5%(16/246),未检出衣原体。<3岁较3~5岁患儿人博卡病毒及总的病毒检出率高,差异有统计学 意义(P<0.05)。 轻度与重度发作患儿病原检出差异无统计学意义(P>0.05)。 不规律吸入糖皮质激素治疗患儿的比例为 78.0%(192/246)。 结论 呼吸道病毒感染是哮喘急性发作的重要原因,且病毒感染对<3岁儿童哮喘急性发作可能更为 重要。

Abstract: Objective To investigate the respiratory pathogens and clinical characteristics among children less than 6 years old and hospitalized with asthma exacerbation. Methods From June 2009 to December 2016, 246 nasopharyngeal aspirate (NPA) from hospitalized children with acute asthma exacerbations were collected, and only one specimen was collected from each child; PCR and q-PCR were performed to detect respiratory syncytial virus (RSV), influenza virus (IFV), parainfluenza virus (PIV), human metapneumovirus (HMPV), coronavirus (CoV), human rhinovirus (HRV), adenovirus (ADV), human bocavirus (HBoV) and mycoplasma. Bacteria isolated at the same time. Results 162 males and 84 females were enrolled in the study, and the median age is 31 months (9-71 months); among them, there were 154 cases younger than 3 years old, and 92 cases aged 3-5 years old; 189 cases were mild asthma exacerbations, and 57 cases were severe asthma exacerbations. The number of hospitalized children with acute asthma in autumn is the highest. Among these 246 NPA specimens, 193 (78.5%) were positive for respiratory viruses, NPA culture was positive in 97 (39.4%), 16 (6.5%) were positive for Mycoplasma pneumoniae, but none was positive for Pneumonia chlamydia. The highest virus detection rate is RSV and HRV, moreover the detection rate of HRVC is significantly higher than other subtypes of HRV(P<0.05) ; HRV detection rate showed increased trend in spring and autumn (P>0.05); RSV has the highest detection rate in winter (P<0.05). Detection rate of human bocavirus and total respiratory virus was significantly increased in children younger than 3 years old; Detection rate of RSV is higher in children younger than 3 years than in children aged 3-5 years, while the difference was not statistically significant (P>0.05); there is no significant difference of HRV detection rate between different age groups (P>0.05). There is no difference in the detection of pathogens in children with mild and severe acute asthma exacerbations (P>0.05). The proportion of irregularly inhaled corticosteroids in hospitalized children with acute asthma exacerbations was 192(78.0%). Conclusions The respiratory pathogens in hospitalized children with acute asthma exacerbations are mainly detected as viruses in our city. The detection of virus is decreased with ages. Respiratory virus infections  are important causes of acute asthma exacerbation in children younger than 6 years, and viral infections may be more important for acute asthma exacerbation in infants and young children.