摘要目的 探讨呼吸道感染患儿重复住院的病因,分析病毒病原学情况及临床特征.方法 收集2009年6月至2011年5月重庆医科大学附属儿童医院急性呼吸道感染患儿鼻咽抽吸物(NPA)标本1746例,患儿年龄为37 d～3岁.提取NPA中病毒核酸,经反转录PCR法检测14种呼吸道病毒,阳性样本采用随机核酸序列测定验证.明确其中包括2次及2次以上住院患儿23例(病例组),将第一次住院病例与除去病例组的住院总体比较,从个体因素、病毒检出及临床特征情况分析重复住院的危险因素；分析第一次住院病毒检出与临床特征的关系,及首次病毒检出、体征阳性病例在第二次住院的变化趋势.结果 重复住院患儿第一次住院、住院总体年龄中位数分别为7个月和8个月,二者比较差异有统计学意义(P ＜0.0001)；重复住院患儿第一次住院流感病毒A、副流感病毒、呼吸道合胞病毒(RSV)、腺病毒、人博卡病毒检出率与同年龄段住院总体比较差异均无统计学意义；重复住院患儿第一次住院喘息率(69.6％)高于住院总体喘息率(47.4％)(P=0.037),重复住院患儿第一次住院腹泻率(52.2％)显著高于住院总体(29.0％)(P=0.017)；重复住院患儿第一次病毒检出与发热、喘息、咳嗽、腹泻等均无相关性.2次住院均以RSV检出率最高,分别为52.2％和30.4％,1例为RSV重复阳性；第一次住院病毒阳性的病例在第二次住院时75.0％(12例)检出病毒；第一次喘息的病例第二次住院时68.8％(11例/16例)表现喘息.结论 呼吸道感染重复住院患儿主要为3岁以内,喘息为重要临床特征；每次感染病毒病原不同,RSV的检出率最高；第一次住院病毒阳性病例第二次住院病毒检出率高；第一次喘息病例第二次发生喘息比例高.

abstractsObjective To explore the causative factors of children with respiratory tract infection and their clinical features.Methods Nasopharyngeal aspirate (NPA) was collected from 1746 children with acute respiratory infections (ARIs),aged from 37 days to 3 years,who were admitted to Children's Hospital of Chongqing Medical University between Jun.2009 and May 2011.Fourteen respiratory viruses in NPA were investigated using polymerase chain reactions (PCR) after nucleic acids extracted from the samples and then synthesized cDNA.Sequence analysis was performed to verify the results of each virus from random positive samples.A total of 23 cases were identified with twice or more admissions to hospital.Individual factors,virus detection and clinical characte-ristics were compared between patients with and without repeated hospitalization.Risk factors for repeated hospitalization were investigated.Then these factors were compared in patients with repeated hospitalization between first time and second time.Results The median age was 7 months in patients with repeated hospitalization and 8 months in patients without repeated hospitalization,there were significantly different difference (P ＜ 0.0001).There was no significant difference in virus detection including influenza type A,parainfluenza,respiratory syncytial virus (RSV),adenovirus and human bocavirus between patients with and without repeated hospitalization in the same age group.By comparing clinical features between patients with and without repeated hospitalizatin in the same age group,(69.6％ vs 47.4％,P =O.037) and diarrhea (52.2％vs 29.0％,P =0.017) were found more often in patients with repeated hospitalization.There was no connection between respiratory virus detection and presence of fever,wheeze,cough and diarrhea in patients with repeated hospitalization for the first time of hospitalization.RSV was the most frequently appeared virus in twice hospitalizations,presenting 52.2％ and 30.4％,respectively.One case had twice positive for RSV.In the first hospitalization,there were 16 viruspositive cases and 16 wheeze cases,while in the second hospitalization,there were 12 virus-positive cases (75.0％)and 11 wheeze cases (68.8％),respectively.Conclusions Children with respiratory tract infections suffered repeated hospitalization,mainly occur in children less than 3 years old.Wheeze is an important clinical feature in children with repeated hospitalization.Although causative viruses for patients in each infection are different,RSV is the most common detected viral agent.Virus-positive cases in the first hospitalization present higher viral detection rate during the second hospitalization,with similar trend for wheeze.