2020 ～ 2021 年呼和浩特市儿童呼吸道腺病毒感染的流行病学和实验室及临床特征研究

目的 研究呼和浩特市儿童呼吸道腺病毒的流行病学特征、实验室指标、临床症状及病原体并发感染。方法 选取 2020年 1月～2021年 12月内蒙古自治区妇幼保健院就诊的急性呼吸道感染的住院患儿 4 266例，采用荧光定量 PCR（real-time polymerase chain reaction，RT-PCR）法对患儿的咽拭子标本进行腺病毒核酸检测，结合一般信息，分析其流行病学及临床特征；将 206例腺病毒核酸检测阳性患儿作为阳性组，另选取 206例核酸阴性患儿作为对照组，阳性组按症状严重程度分为重症组（n=17）和非重症组（n=189），分别比较腺病毒阳性组和对照组、重症组与非重症组的临床特点、实验室生化指标和并发感染等。实验室生化指标包括白细胞（white blood cell，WBC）、中性粒细胞 (neutrophil， NBC)、降钙素原 (procacitonin，PCT)、C反应蛋白 (C-reactive protein，CRP)和乳酸脱氢酶（lactate dehydrogenase， LDH)。结果 4 266例急性呼吸道感染的患儿，腺病毒总阳性率为 4.83%（206/4 266），男性（5.25%，131/2 495）、女性（4.23%，75/1 771）之间差异无统计学意义（χ2=2.325，P>0.05）。夏季（8.14%，74/958）是感染高峰季节， 6月～6岁的儿童容易感染腺病毒（87.86%，181/206），各年龄段阳性率差异有统计学意义（χ2=28.332，P<0.05），其中 6月～1岁感染率（6.72%，33/491）最高。阳性组 CRP5.78（0.93，16.18）mg/L ]和 NBC4.82（2.82，8.20）×109/L]水平高于对照组 3.68（0.50，10.43）mg/L，3.91（2.01，6.61）×109/L]，差异有统计学意义（Z=-2.373，-2.614，均 P<0.05）；重症组 CRP6.91（2.29，14.30）mg/L]和 LDH313.80（278.45，402.30）U/L]水平高于非重症组 1.70（0.50，11.95）mg/L，279.60（249.15，316.50）U/L]，差异有统计学意义（Z=-2.027，-2.744，均 P<0.05）。阳性组发热 ≥ 39℃（58.74%，121/206）、热程 ≥ 9天（14.08%，29/206）、腹泻（8.74%，18/206）和喘息（7.28%，15/206）发生率，与对照组［36.89%（76/206），6.80%（14/206），3.40%（7/206），14.08%（29/206）］相比差异有统计学意义（χ2=19.698，5.842，5.153，4.987，均 P<0.05），重症组喘息症状发生率（35.29%，6/17）高于非重症组（4.76%，9/189），差异有统计学意义（χ2=17.251，P<0.05）。腺病毒阳性组与对照组相比，患儿易并发扁桃体炎、鼻窦炎和胃肠炎（χ2=4.796，10.652，7.828，均 P<0.05）。儿童腺病毒感染的临床症状以支气管肺炎（51.94%，107/206）最多见。腺病毒阳性组中，并发细菌感染率高于并发病毒和支原体感染（χ2=24.793，23.298，均 P<0.05）。结论 呼和浩特市 6月～6岁儿童容易感染腺病毒，引起以支气管肺炎为主的呼吸道疾病，常并发细菌感染，提示本地区应对儿童加强呼吸道腺病毒感染的防治。

Epidemiological,Laboratory Detection and Clinical Characteristics of Respiratory Adenovirus Infection in Children in Hohhot from 2020 to 2021

Objective To study the epidemiological characteristics, laboratory indexes, clinical symptoms and pathogen co-infection of respiratory Adenovirus in children in Hohhot City. Methods A total of 4 266 in patients with acute respiratory tract infection admitted to Maternal and Child Health Hospital of Inner Mongolia Autonomous Region from January 2020 to December 2021 were selected, and the polymerase chain reaction was used to analyze the polymerase chain reaction. RT-PCR was used to detect Adenovirus nucleic acid from throat swab samples of the children. Combined with general information, the epidemiological and clinical characteristics of Adenovirus were analyzed. A total of 206 children with positive Adenovirus nucleic acid test were selected as the positive group, and another 206 children with negative nucleic acid test were selected as the control group. According to the severity of symptoms, the positive group was divided into the severe group （n=17）and the non-severe group（n=189）. The clinical characteristics, laboratory biochemical indicators and co-infection of the Adenovirus positive group and the control group, and the severe group and the non-severe group were compared respectively. Laboratory biochemical indicators mainly include white blood cell (WBC), neutrophil (NBC), procacitonin (PCT), C-reactive protein (C-reactive protein, CRP) and lactate dehydrogenase (LDH). Results In 4 266 children with acute respiratory tract infection, the total positive rate of Adenovirus was 4.83% (206/4 266), and there was no significant difference between males (5.25%, 131/2 495) and females (4.23%, 75/1 771) (χ2=2.325, P>0.05). Summer (8.14%, 74/958) was the peak season of infection, and children aged from June to 6 years were easily infected with Adenovirus (87.86%, 181/206), the positive rate of each age group was significantly different (χ2=28.332, P<0.05), and the infection rate in June to 1 year was the highest (6.72%, 33/491). The levels of CRP5.78 (0.93, 16.18) mg/L] and NBC4.82 (2.82, 8.20)×109/L] in positive group were higher than those in control group 3.68 (0.50, 10.43) mg/L, 3.91 (2.01, 6.61)×109/L]，the differences were statistically significant (Z=-2.373, -2.614, all P<0.05). CRP 6.91 (2.29, 14.30) mg/L] and LDH 313.80 (278.45, 402.30) U/L] levels in critical group were higher than those in non-critical group 1.70 (0.50, 11.95) mg/L, 279.60 (249.15, 316.50) U/L], and the differences were statistically significant (Z=-2.027, -2.744, all P<0.05). The incidence of fever ≥ 39℃ (58.74%, 121/206), heat duration ≥ 9 days (14.08%, 29/206), diarrhea (8.74%, 18/206) and wheezing (7.28%, 15/206) in positive group was significantly different from that in control group36.89%（76/206）, 6.80%（14/206），3.40%（7/206），14.08%（29/206）] (χ2=19.698, 5.842, 5.153, 4.987, all P<0.05). The incidence of wheezing symptoms in the severe group (35.29%, 6/17) was higher than that in the non-severe group (4.76%, 9/189), and the difference was statistically significant (χ2=17.251, P<0.05). Compared with the control group, the children in the Adenovirus positive group were more likely to be complicated with tonsillitis, sinusitis and gastroenteritis (χ2=4.796, 10.652, 7.828, all P<0.05). The most common clinical symptoms of Adenovirus infection in children were bronchopneumonia (51.94%, 107/206). In the Adenovirus positive group, the infection rate of co-bacteria was higher than that of co-virus and mycoplasma (χ2=24.793, 23.298, all P<0.05). Conclusion Children aged from June to 6 years old in Hohhot are easily infected with respiratory Adenovirus, which leads to respiratory diseases mainly bronchopneumonia, often complicated with bacterial infection, suggesting that the prevention and treatment of respiratory Adenovirus infection should be strengthened in children in Hohhot.