39 025例上海儿童呼吸道病原体感染及流行病学特征分析

doi:10.3877/cma.j.issn.1674-6902.2026.01.019

目的

分析儿童呼吸道病原体(病毒与肺炎支原体)的现状及流行病学特征，为临床诊断和治疗，以及做好儿童呼吸道感染性疾病的防控工作提供参考。

方法

选择2024年3月至2025年2月在我院诊断为呼吸道感染性疾病患儿39 025例，采集患儿咽拭子标本，采用Natch 48核酸提取化进行呼吸道六项病原学核酸检测，分别为肺炎支原体(Mycoplasma pneumoniae, MP)、乙型流感病毒(Influenza B virus, FluB)、甲型流感病毒(Influenza A virus, FluA)、呼吸道合胞病毒(Respiratory syncytial virus, RSV)、腺病毒(Adenovirus, ADV)和人鼻病毒(Human rhinovirus, HRV)。

结果

39 025例患儿样本检出病原体阳性22 867例(58.50%)，其中单项病原体阳性患儿19 523例(85.38%)，混合性病原体阳性患儿3 344例(14.62%)。六项病原体阳性中，ADV阳性6 373例(32.64%)、HRV阳性4 745例(24.30%)、MP阳性4 050例(20.75%)、FluA阳性2 293例(11.75%)、RSV阳性1 346例(6.89%)和FluB阳性716例(3.67%)。1个月至1岁幼儿咽拭子检测1 528例，阳性730例(47.77%)，<1岁至3岁患儿检测5 224例，阳性3 950例(75.61%)，<3岁至6岁患儿检测17 887例，阳性7 372例(41.21%)，7岁患儿检测14 386例，阳性7 471例(51.93%)。生活环境散居患儿检测6 752例，阳性4 963例(73.50%)，入幼学患儿检查32 273例，阳性14 827例(45.94%)，患儿不同年龄段检测阳性检出率具有统计学意义(P<0.001)。春季检测8406例，阳性4 032例(47.97%)，夏季检测10 756例，阳性5 818例(54.09%)，秋季检测9 714例，阳性4 934例(50.79%)，冬季检测10 149例，阳性4 739例(46.69%)，患儿不同季节病原体阳性检出率比较(P<0.001)。

结论

儿童呼吸道病原体感染单项以ADV、HRV和MP为最常见，混合性呼吸道病原体感染以HRV和ADV、HRV和MP发生率高，应引起临床重视。应针对流行病学特征制订防控措施，以降低儿童呼吸道病原体感染发生率。

关键词: 儿童, 呼吸道病原体, 流行病学, 混合感染, 上海地区

Objective

To analyze the current status and epidemiological characteristics of different pathogen infections in the respiratory tract of children, providing reference for clinical diagnosis and treatment, as well as for the prevention and control of respiratory infectious diseases in children.

Methods

A total of 39, 025 children diagnosed with respiratory tract infections in our hospital from March 2024 to February 2025 were selected. Pharyngeal swab specimens were collected from these children, and nucleic acid testing for six respiratory pathogens was performed using the Natch 48 nucleic acid extraction method. The pathogens tested were Mycoplasma pneumoniae(MP), Influenza B virus (FluB), Influenza A virus (FluA), Respiratory syncytial virus (RSV), Adenovirus (ADV), and Human rhinovirus (HRV).

Results

Among the 39 025 children tested, pathogens were detected in 22 867 cases (58.5%). Among these, single pathogen infections were found in 19 523 cases (85.38%), and mixed pathogen infections were found in 3 344 cases (14.62%). The distribution of the six pathogens among positive cases was as follows: ADV in 6 373 cases (32.64%), HRV in 4 745 cases (24.30%), MP in 4 050 cases (20.75%), FluA in 2 293 cases (11.75%), RSV in 1 346 cases (6.89%), and FluB in 716 cases (3.67%). Among children aged one month to one year, 1 528 pharyngeal swabs were tested, with 730 positive cases (47.77%). Among children aged >1 to 3 years, 5 224 were tested, with 3 950 positive cases (75.61%). Among children aged >3 to 6 years, 17 887 were tested, with 7 372 positive cases (41.21%). Among 7-year-old children, 14 386 were tested, with 7 471 cases (51.93%). Among children living in home-based care settings, 6 752 were tested, with 4 963 positive cases (73.50%). Among children attending kindergarten, 32 273 were tested, with 14 827 positive cases (45.94%). The difference in positive detection rates among children of different age groups was statistically significant (P<0.001). By season, 8 406 tests were performed in spring, with 4 032 positive cases (47.97%); 10 756 tests in summer, with 5 818 positive cases (54.09%); 9 714 tests in autumn, with 4 934 positive cases (50.79%); and 10 149 tests in winter, with 4 739 positive cases (46.69%). The difference in positive detection rates among children across different seasons was statistically significant (P<0.001).

Conclusion

The most common single pathogens causing respiratory infections in children are ADV, HRV, and MP. Mixed respiratory pathogen infections frequently involve combinations of HRV and ADV, as well as HRV and MP, which should receive clinical attention. Prevention and control measures should be formulated based on epidemiological characteristics to reduce the incidence of respiratory pathogen infections in children.

Key words: Children, Respiratory pathogens, Epidemiology, Mixed infection, Shanghai area

表1 患儿呼吸道病原体感染类型结果分布[n(%)]

临床资料	变　量	送检数	单一病原体感染(n＝19 523)		混合病原体感染(n＝3 344)		χ²值	P值
临床资料	变　量	送检数	阳性数	构成比(%)	阳性数	构成比(%)	χ²值	P值
性别							0.255	0.613
	男	20 330	10 294	50.63	1 779	8.75
	女	18 695	9 229	49.37	1 565	8.37
年龄(岁)							215.374	0.000
	1个月~1	1 528	730	47.78	311	20.35
	1~3	5 224	3 926	75.15	659	12.61
	3~6	17 887	7 438	41.59	1 098	6.14
	>6	14 386	7 429	51.64	1 276	8.87
生活环境							37.832	0.000
	散居	6 752	4 693	69.51	970	14.37
	幼托/学校	32 273	14 830	45.95	2 374	7.36
季节							133.529	0.000
	春	8 406	4 032	47.97	976	11.61
	夏	10 756	5 818	54.09	820	7.62
	秋	9 714	4 934	50.79	741	7.63
	冬	10 149	4 739	46.69	807	7.95

表1 患儿呼吸道病原体感染类型结果分布[n(%)]

临床资料	变　量	送检数	单一病原体感染(n＝19 523)		混合病原体感染(n＝3 344)		χ²值	P值
临床资料	变　量	送检数	阳性数	构成比(%)	阳性数	构成比(%)	χ²值	P值
性别							0.255	0.613
	男	20 330	10 294	50.63	1 779	8.75
	女	18 695	9 229	49.37	1 565	8.37
年龄(岁)							215.374	0.000
	1个月~1	1 528	730	47.78	311	20.35
	1~3	5 224	3 926	75.15	659	12.61
	3~6	17 887	7 438	41.59	1 098	6.14
	>6	14 386	7 429	51.64	1 276	8.87
生活环境							37.832	0.000
	散居	6 752	4 693	69.51	970	14.37
	幼托/学校	32 273	14 830	45.95	2 374	7.36
季节							133.529	0.000
	春	8 406	4 032	47.97	976	11.61
	夏	10 756	5 818	54.09	820	7.62
	秋	9 714	4 934	50.79	741	7.63
	冬	10 149	4 739	46.69	807	7.95

表2 2024年儿童呼吸道病原体混合感染分布[n(%)]

多种病原体感染种类	例数	检出率^a	构成比^b
HRV＋ADV	1 168	5.11	34.92
HRV＋MP	761	3.33	22.76
MP＋ADV	528	2.36	15.79
HRV＋FluA	296	1.29	8.85
RSV＋HRV	223	0.97	6.67
ADV＋FluA	128	0.56	3.83
ADV＋FluB	108	0.47	3.23
RSV＋MP	81	0.35	2.42
MP＋FluB＋RSV	28	0.11	0.84
HRV＋RSV＋FluA	15	0.07	0.45
ADV＋MP＋RSV	8	0.04	0.24
合计	3 344	14.62	100.00

表2 2024年儿童呼吸道病原体混合感染分布[n(%)]

多种病原体感染种类	例数	检出率^a	构成比^b
HRV＋ADV	1 168	5.11	34.92
HRV＋MP	761	3.33	22.76
MP＋ADV	528	2.36	15.79
HRV＋FluA	296	1.29	8.85
RSV＋HRV	223	0.97	6.67
ADV＋FluA	128	0.56	3.83
ADV＋FluB	108	0.47	3.23
RSV＋MP	81	0.35	2.42
MP＋FluB＋RSV	28	0.11	0.84
HRV＋RSV＋FluA	15	0.07	0.45
ADV＋MP＋RSV	8	0.04	0.24
合计	3 344	14.62	100.00

表3 不同病原体感染患儿与并发疾病(例)

病原体种类	上呼吸道感染	支气管炎	肺炎	喘息性支气管炎
MP	59	1 121	2 316	543
HRV	2 997	1 978	934	486
FluA	1 443	342	451	231
ADV	5 321	347	658	81
FluB	691	43	96	8
RSV	255	743	445	229

表3 不同病原体感染患儿与并发疾病(例)

病原体种类	上呼吸道感染	支气管炎	肺炎	喘息性支气管炎
MP	59	1 121	2 316	543
HRV	2 997	1 978	934	486
FluA	1 443	342	451	231
ADV	5 321	347	658	81
FluB	691	43	96	8
RSV	255	743	445	229

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Analysis of respiratory pathogen infections and epidemiological characteristics in children in shanghai area

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Analysis of respiratory pathogen infections and epidemiological characteristics in children in shanghai area