2018－2021年新疆维吾尔自治区乌鲁木齐市5岁以下住院患儿病毒性腹泻病原学特征分析

沙比热木·托合塔木; 王婷; 买斯吐热·尼加提; 沙比拉·吐拉江; 马合木提

doi:10.3784/jbjc.202211040488

2018－2021年新疆维吾尔自治区乌鲁木齐市5岁以下住院患儿病毒性腹泻病原学特征分析

Etiological characteristics of viral diarrhea in hospitalized children under 5 years old in Urumqi, Xinjiang, 2018−2021

摘要

摘要:
目的分析新疆维吾尔自治区（新疆）乌鲁木齐市＜5岁腹泻住院患儿病毒性腹泻流行病学及病原学特证，为病毒性腹泻病的防控工作提供依据。
方法收集2018 年1月至2021年12月乌鲁木齐市哨点医院＜5岁因腹泻住院患儿粪便标本和相关流行病学信息，采用实时荧光定量聚合酶链式反应检测方法筛查标本中的A组轮状病毒（RVA）、诺如病毒（NV）、札如病毒（SaV）、星状病毒（AstV）和肠道腺病毒（EAdV）5种病毒的核酸。采用巢式反转录聚合酶链式反应（RT-PCR）方法对RVA和NV进行G和P基因分型检测。
结果 4年共检测粪便标本1173份，检出阳性865份，总阳性率为73.7%，4年5种病毒阳性率分别为 RVA（40.8%、54.4%、53.2%、53.9%），NV（20.4%、18.5%、22.6%、26.8%），EAdV（11.%、12.7%、8.6%、13.4%），AstV（2.8%、3.0%、0.5%、2.9%）和SaV（3.8%、4.9%、0.5%、2.6%）。其中单一病毒构成比分别为83.9%、75.5%、75.0%、76.8%，混合感染构成比分别为16.1%、24.5%、25.0%、23.2%。不同月龄段分布中，13～24月龄段检出率最高79.3%（371/468），37～59月龄段阳性率最低60.3%（73/119），不同月龄段中阳性率差异有统计学意义（χ²＝24.482，P＜0.001）。男女性之间阳性率分别为72.9%（510/700）、75.1%（355/473），不同性别间差异有统计学意义（χ²＝1173.000，P＜0.001）。冬春季高发分别为86.0%（259/301）、82.4%（229/278）。 4个不同季度间阳性率差异有统计学意义（χ²＝102.576，P＜0.001）。农村患儿阳性率为74.5%（184/247），高于城市患儿73.5%（681/926），城市和农村间阳性率差异有统计学意义（χ²＝1173.000，P＜0.001）。 RVA阳性病例中G9P［8］型处于优势地位82.1%（485/591），NV 中GⅡ基因型为主94.9%（243/256）。
结论 RVA和NV是乌鲁木齐市＜5岁腹泻住院患儿的主要病原，2岁以下婴幼儿是RVA免疫接种的重点人群，根据优势病原和高发季节，对该地区采取有针对性的防控措施。

Abstract:
Objective To understand the epidemiological and etiological characteristics of viral diarrhea in <5 years old children hospitalized due to diarrhea in Urumqi, Xinjiang Uygur Autonomous Region, and provide evidence for the prevention and control of viral diarrhea.
Methods Stool samples and related epidemiological information of <5 years old children hospitalized due to diarrhea in sentinel hospitals in Urumqi were collected from January 2018 to December 2021, and the samples were screened for the nucleic acids of five viruses, including rotavirus A (RVA), norovirus (NV), sapovirus ( SaV), astrovirus (AstV) and enteric adenovirus (EAdV), using real-time fluorescence quantitative PCR. G and P genotyping of RVA was performed by nested reverse transcription polymerase chain reaction (RT-PCR).
Results A total of 1173 stool samples were tested in the four years and 865 were found to be positive, with an overall positive rate of 73.7%. The positive rates of the five viruses in the four years were as follow: RVA: 40.8%, 54.4%, 53.2%, 53.9%, NV: 20.4%, 18.5%, 22.6%, 26.8%, EAdV: 11.0%, 12.7%, 8.6%, 13.4%, AstV: 2.8%, 3.0%, 0.5%, 2.9% and SaV: 3.8%, 4.9%, 0.5%, 2.6%. The proportions of single virus positive detection were 83.9%, 75.5%, 75.0% and 76.8%, respectively, and the proportions of multiple virus positive detection were 16.1%, 24.5%, 25.0% and 23.2%, respectively. The distribution by age of month showed that the highest detection rate was in age group 13–24 months (79.3%, 371/468) and the lowest positive rate was in age group 37−59 months (60.3%, 73/119), the differences in the positive rate were significant among different age groups (χ²=24.482, P<0.001). The positive rates was 72.9% in boys (510/700) and 75.1% in girls (355/473), the difference was significant (χ²=1173.000,P<0.001). The positive rate were high in winter (86.0%, 259/301) and spring ( 82.4%, 229/278), the differences among different seasons were significant (χ²=102.576, P<0.001). The positive rate was 74.5% in rural children (184/247), higher than that in urban children (73.5%, 681/926), the difference was significant (χ²= 1173.000, P<0.001). In the RVA positive cases, G9P［8］ was predominant (82.1%, 485/591), and in NV positive cases, GⅡ was predominat (94.9%, 243/256).
Conclusion RVA and NV were the main pathogens in <5 years old children hospitalized due to diarrhea in Urumqi. Children aged <2 years are key population for RVA vaccination. It is necessary to take targeted prevention and control measures in this area according to the predominant pathogen and disease seasonality.

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