Respiratory Pathogens Screening and Clinical Characteristics Analysis for Pediatric Acute Rhinosinusitis Patients

2016-09-23MAIAiLUOYashaZHONGGuoyuWEIFengguiCHENDehuiWEIXiaopingZHOUQiangLINYongping

世界复合医学 2016年3期

MAI Ai,LUO Ya-sha,ZHONG Guo-yu,WEI Feng-gui,CHEN De-hui,WEI Xiao-ping,ZHOU Qiang,LIN Yong-ping

1.Department of ENT,the First Affiliated Hospital of Guangzhou Medical University，Guangzhou,Guangdong Province,510120 China; 2.Department of Laboratory,Guangdong Provincial Maternity and Child Care Center,Guangzhou,Guangdong Province,511442 China; 3.Department of Pediatrics,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong Province,510120 China;4.Department of Clinical Laboratory,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong Province,510120 China;5.The Second Affiliated HospitalClinical Laboratory of Guangzhou University of Chinese Medicine, Guangzhou,Guangdong Province,510120 China

Respiratory Pathogens Screening and Clinical Characteristics Analysis for Pediatric Acute Rhinosinusitis Patients

MAI Ai1,LUO Ya-sha2,ZHONG Guo-yu3,WEI Feng-gui3,CHEN De-hui3,WEI Xiao-ping4,ZHOU Qiang5,LIN Yong-ping4

Objective Acute upper respiratory tract infection (AURI)is a common disease in most pediatric outpatients,and viral etiologies have been shown to play an important role.However,the URI infection following to result most pediatric sinus infections,which is known to damage the nasal/sinus epithelial cells and cilis.Therefore,the pathogens screening and clinical characteristics analysis were conducted to determine the prevalence of viruses in acute rhinosinusitis (ARS)and controls groups.Methods Nasal swab(NS) samples were collected from 564 pediatric outpatients,which were 259 ARS patients(group I),219 AURIs patients(group II)and 86 controls(group III)respectively.Multiplex PCR was used to identify respiratory viruses in each group and the pathogens were compared with each other.Results The datas were shown that infected with respiratory viruses would increase 3.104-fold risk become RS (RR=3.104,95%CI=2.134～4.517).Only RV and ADV had a higher rate in group I than group II(P＜0.05),the rest pathogens shown no significant difference either(P＞0.05).RV infection rate in group Ia(ARS only)was absolutely higher than other groups(P＜0.01), ADV was more prevalent in the AURI population with ARS(group Ib)(P＜0.05).Effusion of immune cells have been found in 49.6% group I samples by cell smearing analysis,which nearly equal to the pathogen detection rate of group I(47.4%).Conclusion This investigation proved that RV and ADV contribute more on ARS development,especially RV,which made children have more chance developing to ARS with the neutrophils and lymphocyte effusion in nasal mucosa.Further studies should be done to generalize the research by incresing sample capacity and collecting ARS patients from different hospital during continuous seasons.

Acute sinusitis in Children；Rpathogens;Screenin

Acute rhinosinusitis(ARS)is a common problem in children with acute upper respiratory tract infections(AURIs), while AURIs is the largest number of disease in pediatric outpatients.Recent evidence shows that most URIs are caused by viruses,but the viral screening and clinical characteristics analysis for pediatric of acute RS are not well understood.Since rhinitis and sinusitis in pediatric patients are often a continuous disease according to the anatomical characteristics in children[1],it is not possible to distinct rhinitis from sinusitis on clinical espression individually.Recognition of history and symptoms are important to establish a diagnosis of RS due to which is still often under-diagnosed in practical pediatric.Research has shown that the the most common RS symptoms were rhinorrhea,cough,post-nasal drip and nasal congestion,and most symptoms and signs in acute and chronic RS were similar[2].In addition,RS is a multifactorial disease,which is the several predisposing factors changes with increasing age[3-4].Therefore,more continued research in these fields should be done to determine the most safe and effective methods to prevent and treat RS in children.

急性上呼吸道感染是儿科门诊中就诊数量最多的疾病，而急性鼻窦炎是小儿急性上呼吸道感染中的常见问题。最新研究表明大多数的上呼吸道感染是由病毒引起的，但对小儿急性鼻窦炎的病毒筛查和临床特点分析尚不明确。根据儿童的解剖特点，鼻炎和鼻窦炎在儿科患者中往往是一种连续性疾病，因此，两者的临床表现难以区分。由于鼻窦炎在目前的儿科就诊患儿中容易漏诊，所以对其疾病史和症状的认知对诊断该疾病很重要的。研究表明最常见的鼻窦炎症状是流鼻涕，咳嗽，鼻塞，鼻后滴流，急性鼻窦炎和慢性鼻窦炎的大多数症状和体征相似。此外，鼻窦炎是由多因素引起的疾病，随着年龄的增加多种诱因也随之改变。因此，应该开展更多关于该领域的研究来决定预防和治疗小儿鼻窦炎的最安全最有效的方法。

Viral etiologies have shown virus play an important role in the AURI pediatric which following to result most sinus infections,was known to damage the nasal/sinus epithelial cellsandcilis[5].After samples were collected from control groups without ARS,the respiratory pathogens rate was compared with that in ARS subjects.These data proved that some specific virus would made children have more chance developing to ARS with plenty of neutrophils effusion in nasal mucosa.

病毒病因学表明病毒在小儿急性上呼吸道感染中起很大作用，会导致进一步的鼻窦感染，而鼻窦感染会损伤鼻窦黏膜上皮细胞。从没有患急性鼻窦炎的对照组中采集样本之后，该研究将患有急性鼻窦炎的受试组的呼吸系统病原体感染率与其相比较。研究数据表明一些特定的病毒会增加儿童感染急性鼻窦炎的风险，并且鼻黏膜会有大量的中性粒细胞渗出。

MATERIALS AND METHODS

Patient population.Five hundred sixty-four pediatric out-patients were recruited between July 2013 and June2014 at 1st Affiliated Hospital of Guangzhou Medical University,China,of whom with a ARS diagnosis were divided into group I(259),including a subgroup Ia (95)only with ARS and a subgroup Ib(164)both with ARS and AURIs.The other 219 simple AURIs children who didn’t have any nasal symptoms were divided into group II,and group III(86)were control volunteers who have neither ARS nor AURIs.All rhinosinusitis patients met the established diagnostic criteria[6]for ARS,which the most common symptoms were rhinorrhea, cough,post-nasal drip and nasal congestion,and the persistent symptoms for more than 10 days but less than 4 weeks. The diagnosis of AURIs is usually made from the history and presenting symptoms,which can include cough,wheeze and fever,among others,also the persistent symptoms for more than 10 days but less than 4 weeks.Asthma and allergic disease were excluded from the study.All the legally authorized representatives of children provided informed consent.