摘要目的 探讨儿科重症监护病房患儿的病毒病原谱特点及其临床意义.方法 收集汕头大学医学院第二附属医院儿科重症监护病房患儿的咽拭子标本349份,同时收集该349例病例中因发热抽搐而需行腰椎穿刺术的患儿脑脊液标本130份,选取社区健康体检儿童87份咽拭子作为健康对照组.应用多重PCR技术,对咽拭子和脑脊液标本进行16种呼吸道病毒检测,同时应用荧光实时PCR技术,对脑脊液标本检测13种脑炎相关病毒,并对阳性病例的临床资料进行分析.结果 349份咽拭子标本中,病毒阳性209例(59.9％),其中鼻病毒117例,呼吸道合胞病毒60例,流感病毒A 20例,腺病毒10例,副流感病毒-3 6例,博卡病毒6例,流感病毒C5例,副流感病毒4 4例,冠状病毒HJYl/OC43 4例,流感病毒B3例,WU多瘤病毒3例,副流感病毒-l 2例,偏肺病毒2例,冠状病毒NL63/229E l例.87名健康儿童呼吸道病毒检测均为阴性.130例留取脑脊液标本的病例中,最后诊断为病毒性脑炎58例,病毒阳性22例(37.9％),其中肠道病毒通用型14例,巨细胞病毒3例,腮腺炎病毒2例,柯萨奇A16型l例,单纯疱疹病毒1例,鼻病毒1例.349例入选病例中,咽拭子和脑脊液病毒检测总阳性率为63.3％ (221/349).同一患儿检测到病毒混合感染45例(12.9％),占所有病毒阳性病例的20.4％.混合感染率最高为WU多瘤病毒(100％,3/3)和人偏肺病毒(100％,2/2).病毒阳性病例中,年龄＜6个月病毒感染率最高(72.2％),男性(148例)明显多于女性(73例).病毒阳性组中非危重病例少于病毒阴性组,而极危重病例则多于阴性组.结论 病毒是儿童重症感染性疾病的重要病原体,病毒感染可能导致病情加重,全面监测儿科重症监护病房病毒病原谱,对于提高感染性疾病诊断的准确性及治疗的针对性具有重要的临床意义.

abstractsObjective To study the characteristics of viral spectrum and clinical features of children in pediatric intensive care unit (PICU).Method Nasopharyngeal aspirate specimens (NPA) from 349 patients(1 from each) and 130 cerebrospinal fluids (CSF) specimens were collected from children who were admitted to the PICU of Second Affiliated Hospital of Shantou University Medical College.Additional 87 NPA specimens were collected from healthy children for routine examination on the physical examination center,and the clinical data were collected.Multiplex PCR was applied to detect 16 kinds of viruses from NPA and CSF.Fluorescence quantitative PCR was applied to detect 13 viruses from CSF and to analyze the clinical data of positive cases.Result There were 209 samples (59.9％) of the 349 NPA specimens were positive for viruses,which included 117 cases positive for human rhinovirus (HRV),60 for respiratory syncytial virus (RSV),20 for influenza virus A (Inf A),10 for adenovirus (ADV),6 for parainfluenza virus type 3 (PIV-3),6 for human Boca virus (HBoV),5 for influenza virus C (Inf C),4 for parainfluenza virus type 4 (PIV-4),4 for human coronavirus-HKU1/OC43,3 for influenza virus B (Inf B),3 for WU Polyomavirus (WUPyV),2 parainfluenza virus type 1 (PIV-1),2 human metapneumovirus (HMPV) and 1 human coronavirus-NL63/229E.But none from 87 healthy controls were positive for any respiratory virus.Among the 130 CSF specimens,in 58 eases the diagnosis was viral encephalitis.There were 22 samples (37.9％) among the 58 CSF specimens positive for viruses,which included 14 enterovirus (EV),3 human cytomegalovirus (HCMV),2 mumps virus,1 coxsackie virus A16 (Cox-A16),1 herpes simplex virus (HSV) and 1 human rhinovirus (HRV).The total positive rate was 63.3％ (221/349).Co-infection by at least 2 viral pathogens under study was observed in 45 of the 349 patients (12.9％ of the total number of cases,20.4％ of the positives cases).The commonest pathogens in co-infected samples were WUPyV (100％) and HMPV(100％).The positive rate of virus peaked in the first 6 months of life,the rate in boys were higher than in girls and the peak season was summer.The numbers of none serious eases in the virus positive group were less than those in the virus negative group while the numbers of extremely serious cases in the virus positive group were higher than in the virus negative group.Conclusion Viral pathogen is a major cause of infectious disease in pediatric critical illnesses and virus infection may lead to severe illness.