抽象
这是第一个报告,审查不同RV种类在入院儿科ICU的儿童中的不同RV种类的作用。我们的研究发现,RV-C是儿科重症监护呼吸录取中最常见的RV物种。http://ow.ly/P6EN30k9UnX
至编辑:
急性呼吸道疾病(ARIS)占儿科重症监护单位(PICU)的所有入学委员会的10-15%[1]。Historically, respiratory syncytial virus was reported to be the most common viral pathogen resulting in admission to the PICU [2]。R.ecent studies, using more sensitive molecular techniques, have shown that rhinoviruses may be the most frequent virus detected in respiratory admissions to a PICU [3.-5.]。
我们此前据报道,鼻病毒-C物种与更频繁的呼吸录取有关[6.那7.]。T.here has been no study reported to date examining the prevalence of each rhinovirus species in children admitted with an ARI to the PICU.
本研究的目的是确定不同病毒,特别是鼻病毒物种的患病率,患有ARI的儿童。
Patient information was obtained retrospectively from the hospital computer database as part of an audit on all children admitted with an ARI to the PICU at Princess Margaret Hospital (PMH), Perth, Australia, between March 2009 and July 2011.
我们将这些数据与来自PMH运行的并发前瞻性研究中的数据进行了比较,检查儿童急性病毒性呼吸道感染的机制(MAVric)[7.]。Mavric研究注册了患有急性哮喘,支气管炎和肺炎的急诊肿瘤的儿童。我们将PICU队列与上述ARI的所有案例进行比较,不需要在同一时间框架上招募到MAVRIC研究的PICU入学。
Detection of common respiratory viruses from nasopharyngeal aspirate (NPA) samples were completed as previously described [6.那8.-10]。
从2009年3月到2011年7月,总共260名儿童被ARI录取了PICU。在这种队列中,229(88.1%)进行了NPA。平均值sd年龄为2.8±4.0(0-16)年,最常见的呼吸诊断是急性哮喘(n = 63; 27.5%),支气管炎(n = 67; 29.3%)和肺炎(n = 44; 19.2%)。
rhinovirus是检测到的最常见的病毒;存在于94例(41.0%)的NPA样品中。在50(21.8%)样品中鉴定了呼吸合胞病毒。
Based on the analysis of prevalence of rhinovirus species, rhinovirus-C was the most common rhinovirus species detected, being present in 51 (22.3%) of the 229 samples (figure 1). Rhinovirus-A species was found in 40 (17.5%) and rhinovirus-B in 4 (1.7%) of the overall PICU cohort.
总共260名患者与ARI进入PICU,31例(11.9%)没有采取NPA。将这些患者的人口统计数据与患有NPA进行的PICU呼吸道入学进行比较。没有进行NPA的儿童年龄较大(6.41±5.34与2。8.±4.0 years; p<0.001) and more likely to have a diagnosis of pneumonia (35.5%与19.2%;p = 0.01)。
在这项研究中,时间181应急管理artment ARI cases were recruited to the MAVRIC study and these subjects were compared with the cohort admitted to the PICU. Patients admitted to the PICU were more likely to stay in hospital longer (23.7±54.5与1.4±1.39天;P <0.001)并具有共发病率(n = 88,38.4%与n=0; p<0.001) compared with emergency department ARI cases admitted to the ward.
受试者承认PICU与急诊署ARI病例不太可能诊断哮喘(27.5%)与分别为66.8%;P <0.001)但更有可能诊断肺炎(19.6%)与5.6%;P <0.001)。rhinovirus-c是两套医院病例中检测到的最常见的鼻病毒物种。两组之间没有任何特定病毒之间没有统计差异。
在229名儿童入住的是NPA的PICU,24个(10.5%)与另一种病毒有一种共感染。比较对检测到一种病毒的儿童进行共同感染的儿童的临床结果,两组之间没有统计学上有显着差异。
这项研究表明,rhinovirus is the most common virus identified in children admitted to a PICU with an ARI and rhinovirus-C is the most frequent rhinovirus species detected in children positive for rhinovirus. Importantly, our data show that rhinovirus-C is a common viral pathogen detected in PICU ARI admissions and as common, or perhaps even more common than respiratory syncytial virus.
T.his is the first study to systematically examine relationships between respiratory viruses and different rhinovirus species in children admitted to a PICU with an ARI and, to our knowledge, is the largest study in a PICU population using RT-PCR rhinovirus molecular typing methods. Previous studies either did not include rhinovirus typing and used older virological detection methods [2] or were too small to report specifically on the prevalence of rhinovirus species [3.那4.]。
我们的研究组先前已经证明,与其他鼻病毒物种相比,学龄前儿童的鼻病毒-C相关喘息发作与先前和随后的呼吸医院入学的风险增加[7.]。R.ecent experimental evidence established that rhinovirus-C species has the ability to grow equally well at both 34°C and 37°C [11[有助于解释为什么rhinovirus-C物种经常在儿童严重的下呼吸道疾病中发现。
本研究中的主要优势包括使用最新,高度敏感的PCR技术,并且它包括多种不同季节的不同呼吸诊断。通过纳入对照组,我们研究中的研究结果得到了加强。虽然两组的临床人口统计数据有一些差异,但Mavric ARI案件提供了有关使用ARI进入PICU的儿童不同病毒的频率的证据。
In this study, viral detection data was not available on 31 (11.9%) of the overall PICU respiratory admissions. These children were older and more likely to have a diagnosis of pneumonia. NPAs are not routinely performed on older children given the level of discomfort associated with the procedure. Both the PICU and emergency department ARI cohorts where an NPA was performed were mainly younger pre-school children admitted with either bronchiolitis or asthma. Previous studies have demonstrated a similar frequency and distribution of rhinovirus infections in preschool children with wheezing disorders verifying our findings [7.那12-15.]。确定鼻病毒物种所需的分析需要91(40%)收集的NPA不再可用于鼻病毒键入。鉴于该子分析的大小并且这些样本的可用性随机,可以预期数据所报告的数据代表与ARI进入PICU的儿童的不同鼻病毒物种的分布。
In conclusion, this is the first report examining the role of different rhinovirus species in ARIs in children admitted to a tertiary PICU. Rhinovirus was the most common virus detected and rhinovirus-C was the most prevalent rhinovirus species detected. Rhinovirus-C was also the most common rhinovirus species detected in children admitted to the PICU with a diagnosis of either acute asthma or bronchiolitis. Importantly, rhinovirus-C was as commonly detected in PICU admissions as respiratory syncytial virus.
脚注
利益冲突:P.N.LeSouīf在研究期间报道了国家卫生和医学研究委员会澳大利亚国家卫生和医学研究理事会澳大利亚的补助金(计划赠款编号APP458513)。
支持声明:本研究得到国家卫生和医学研究委员会(NHMRC)资金支持。本文的资金信息已存入CrossRef Resder注册表。
- R.eceived2018年1月31日。
- 公认May 13, 2018.
- 复制right ©ERS 2018