甘肃省儿童急性下呼吸道感染病原流行病学特征

曹文珮; 马晶; 李娟生; 任晓卫; 申希平; 刘小宁

doi:10.16462/j.cnki.zhjbkz.2020.02.002

甘肃省儿童急性下呼吸道感染病原流行病学特征

doi: 10.16462/j.cnki.zhjbkz.2020.02.002

730000 兰州, 兰州大学公共卫生学院

基金项目: 国家科技重大专项(2012ZX10004-208)

详细信息

通讯作者:
刘小宁, E-mail:liuxn@lzu.edu.cn

中图分类号: R181
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出版历程
- 收稿日期: 2019-07-02
- 修回日期: 2019-11-01
- 刊出日期: 2020-02-10

Epidemiological characteristics of acute lower respiratory tract infection in children in Gansu Province

School of Public Health, Lanzhou University, Lanzhou 730000, China

Funds: National Science and Technology Major Project of China(2009ZXl0004-208)

More Information

Corresponding author: LIU Xiao-ning, E-mail:liuxn@lzu.edu.cn

摘要

摘要: 目的了解2012-2015年甘肃省儿童急性下呼吸道感染(acute lower respiratory tract infection, ALRTI)病原流行病学特征。方法收集2012-2015年甘肃省10家哨点医院458例感染ALRTI患儿的病例监测数据, 通过描述性流行病学方法分析各病毒和细菌感染状况与流行病学特征。结果 458例儿童ALRTI患者中男女比例为1.81:1, 病毒的阳性检出率为33.62%(95% CI:29.28%~37.97%), 其中呼吸道合胞病毒的阳性检出率居于首位(12.23%); 细菌的阳性检出率为24.84%(95% CI:20.04%~29.65%), 其中分离出肺炎链球菌阳性的患者检出率最高(18.47%); 不同性别儿童病毒阳性检出率与细菌阳性检出率均没有差别(均有P > 0.05);不同年龄儿童病毒阳性检出率无差别(χ²=5.980, P=0.050), 而细菌阳性检出率不同(χ²=12.078, P=0.002), 不同季节病毒感染阳性检出率和细菌感染阳性检出率均有差异(均有P < 0.05), 经Logistics回归分析得, 季节、年龄和哨点医院是儿童ALRTI病毒的影响因素(均有P < 0.05), 而哨点医院和年份是影响细菌感染的因素(均有P < 0.05)。结论甘肃省0-14岁儿童ALRTI以呼吸道合胞病毒、流感病毒和副流感病毒为主, 细菌感染以肺炎链球菌和流感嗜血杆菌为主, 其中病毒感染人数较细菌感染人数多, 病毒和细菌感染存在相同的发病高峰。
- 病原 /
- 流行病学特征 /
- 儿童急性下呼吸道感染
Abstract: Objective To analyze the pathogenic epidemiological characteristics of acute lower respiratory tract infection(ALRTI) in children in Gansu Province from 2012 to 2015. Methods The surveillance data of 458 children infected with ALRTI in 10 sentinel hospitals in Gansu province from 2012 to 2015 were collected, and infection status and epidemiological characteristics of each virus and bacteria were analyzed by descriptive study methods. Results The male to female ratio of the 458 children with ALRTI was 1.81:1, and the positive detection rate of the virus was 33.62%(95% CI:29.28%-37.97%), among which the positive detection rate of respiratory syncytial virus was the highest(12.23%).The positive detection rate of bacteria was 24.84%(95% CI:20.04%-29.65%), among which the positive detection rate of streptococcus pneumoniae was the highest(18.47%).There was significant no difference in the positive detection rate of virus and bacteria between children of different genders(P > 0.05).There was significant no difference in the positive detection rate of virus among children of different age groups(χ²=5.980, P=0.050), but the positive detection rate of bacteria was different(χ²=12.078, P=0.002).Positive detection rates of virus infection and bacterial infection were different in distinct seasons(all P < 0.05). By using logistics regression analysis, season, age and sentinel hospital were the influencing factors of ALRTI virus infection in children(allP < 0.05), and sentinel hospital and years were the influencing factors of ALRTI bacterial infection in children(allP < 0.05). Conclusion Respiratory syncytial virus, influenza virus and parainfluenza were the main causes of ALRTI virus infection in children aged 0-14 years in Gansu province, and the main bacterial infections were streptococcus pneumoniae and haemophilus influenzae, the number of virus infection was more than that of bacterial infection. Viral and bacterial infection had the same peak incidence.
- Etiology /
- Epidemiological characteristics /
- Acute lower respiratory tract infection of children

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图 1 2012-2015年甘肃省458例儿童急性下呼吸道感染病例病原体感染情况

Figure 1. Pathogen infection of 458 cases of ALRTI in children in Gansu Province during 2012-2015

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图 2 甘肃省0-14岁ALRTI儿童病原体阳性检测人数月份分布情况

Figure 2. Monthly distribution of the number of positive pathogen tests in ALRTI children aged 0-14 years in Gansu province

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表 1 2012-2015年甘肃省458例儿童急性下呼吸道感染病例病原体季节和年分布情况

Table 1. Seasonal and annual distribution of pathogens of 458 cases of ALRTI in children in Gansu province during 2012-2015

季节	检测例数	病毒阳性		细菌阳性		χ²值	P值
季节	检测例数	例数	阳性率(%)	例数	阳性率(%)	χ²值	P值
2012年
冬季	39	16	41.03	1	2.56	16.920	< 0.001
春季	27	6	22.22	4	14.81	0.491	0.484
夏季	7	1	14.29	2	28.57	0.424	0.515
秋季	3	0	0.00	2	66.67	3.000	0.083
合计	76	23	30.26	9	11.84	-	-
2013年
冬季	23	8	34.78	5	21.74	0.965	0.326
春季	45	6	13.33	7	15.56	0.090	0.764
夏季	29	4	13.79	7	24.14	1.010	0.315
秋季	14	7	50.00	6	42.86	0.144	0.705
合计	111	25	22.52	25	22.52	-	-
2014年
冬季	36	12	33.33	6	16.67	2.667	0.102
春季	55	31	56.36	12	21.82	13.783	< 0.001
夏季	34	7	20.59	6	17.65	0.095	0.758
秋季	31	6	19.35	10	32.26	1.348	0.246
合计	156	56	35.90	34	21.79	-	-
2015年
冬季	71	37	52.11	4	5.63	37.343	< 0.001
春季	9	1	11.11	0	0.00	1.059	0.303
夏季	11	2	18.18	0	0.00	2.200	0.138
秋季	24	10	41.67	6	25.00	1.500	0.221
合计	115	50	43.48	10	8.70	-	-
注:春季:当年3-5月份, 夏季:当年6-8月份, 秋季:当年9-11月份, 冬季当年12月份及次年1-2月份。

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表 2 2012-2015年甘肃省458例儿童急性下呼吸道感染病例病原体感染性别年龄和季节分布情况(%)

Table 2. Sex, age and seasonal distribution of pathogen infection of 458 cases of ALRTI in children in Gansu province during 2012-2015(%)

类别	Flu	RSV	PIV	ADV	hMPV	HCoV	HBoV	HRV	任一病毒阳性	任一细菌阳性
性别
男	3.93	6.99	4.59	1.09	1.31	1.53	0.87	3.71	20.31	16.56
女	2.84	5.24	1.53	1.75	0.87	0.87	0.44	1.97	13.32	8.28
年龄(岁)
< 1	1.53	7.21	1.09	0.22	0.22	0.66	0.44	1.97	11.79	8.60
1~	3.06	4.59	4.37	2.18	1.75	0.87	0.66	2.40	16.38	9.55
6~14	2.18	0.44	0.66	0.44	0.22	0.87	0.22	1.31	5.46	6.69
季节
春(3-5月)	1.53	3.49	2.18	0.87	1.53	0.66	0.44	1.09	9.61	7.32
夏(6-8月)	0.00	0.22	0.22	0.66	0.00	0.87	0.22	1.09	3.06	4.78
秋(9-11月)	1.09	0.44	1.97	0.22	0.22	0.22	0.00	1.75	5.02	7.64
冬(12-2月)	4.15	8.08	1.75	1.09	0.44	0.66	0.66	1.75	15.94	5.10
注:呼吸道合胞病毒(RSV)、人鼻病毒(HRV)、流感病毒(Flu)、人副流感病毒(PIV)、人腺病毒(ADV)、人博卡病毒(HBoV)、人偏肺病毒(hMPV)以及人冠状病毒(HCoV)。

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表 3 2012-2015年甘肃省0~14岁儿童ALRTI病毒多重感染状况的构成比

Table 3. Constituent ratio of co-infection with ALRTI virus in children aged 0-14 years in Gansu province during 2012-2015

检测出两种及以上病毒	例数	构成比(%)
Flu+RSV	5	17.24
Flu+HCoV	3	10.34
RSV+HRV	3	10.34
Flu+hMPV	2	6.90
ADV+HCoV	2	6.90
RSV+PIV	2	6.90
RSV+hMPV	2	6.90
PIV+ADV	2	6.90
PIV+hMPV	2	6.90
Flu+ADV	1	3.45
PIV+HRV	1	3.45
ADV+HBoV	1	3.45
hMPV+HCoV	1	3.45
Flu+ADV+HCoV	1	3.45
Flu+RSV+hMPV	1	3.45
合计	29	100.00

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表 4 2012-2015年甘肃省0~14岁儿童ALRTI病原体阳性logistics回归分析

Table 4. Logistic regression analysis of ALRTI positive pathogen in children aged 0-14 years in Gansu province during 2012-2015

回归因素	病毒			细菌
回归因素	OR(95% CI)值	P值	OR(95% CI)值	P值
季节
春	1.00		1.00
夏	0.64(0.35~1.18)		2.32(0.86~6.29)
秋	0.30(0.14~0.67)		1.14(0.35~3.76)
冬	0.58(0.28~1.17)	0.028	3.40(1.15~10.07)	0.088
年龄(岁)
< 1	1.00		1.00
1~	0.39(0.19~0.80)		0.48(0.17~1.34)
6~14	0.81(0.42~1.57)	0.008	0.40(0.15~1.07)	0.175
哨点医院
甘南州人民医院	1.00		1.00
甘肃省人民医院	0.37(0.09~1.63)		0.06(0.01~0.78)
靖远县人民医院	0.79(0.25~2.45)		5.44(1.21~24.49)
兰州大学第二医院	2.28(0.57~9.13)		~
兰州大学第一医院	0.68(0.20~2.32)		0.23(0.04~1.29)
凉州区人民医院	0.06(0.01~0.26)		0.01(0.00~0.16)
庆阳市人民医院	1.36(0.47~3.93)		0.16(0.03~0.82)
天水市第二人民医院	0.31(0.10~0.99)		0.02(0.00~0.21)
天水市第一人民医院	0.54(0.14~2.09)		1.39(0.26~7.37)
张掖市人民医院	0.57(0.16~2.03)	< 0.001	-	< 0.001
年份
2012年	1.00		1.00
2013年	0.42(0.20~0.86)		1.09(0.24~4.88)
2014年	1.17(0.53~2.60)		4.36(1.05~18.08)
2015年	0.92(0.42~2.03)	0.088	0.94(0.26~3.48)	0.039

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