儿童轮状病毒性肠炎季节性分布特征及预防策略探讨

Seasonal distribution characteristics and prevention strategies of rotavirus enteritis in children

摘要

目的 探究儿童轮状病毒性肠炎(RVE)季节性分布特征及预防策略。方法 选择2020年1月至2022年12月本院收治的腹泻患儿(246例)为研究对象,纳入训练集;根据RV抗原检测结果,分为RVE组(132例)和非RVE组(114例).按照相同标准,另选腹泻患儿(82例)纳入验证集.收集患儿的临床资料,分析RVE发病季节及月份分布情况,以及两组患儿的临床资料和生化指标.采用多因素Logistic回归分析危险因素,构建列线图预测模型并评价。结果 本地区RVE多见于冬春季,其中12月至次年3月为RVE高发期,其发病情况占全年的59.09%.有吮指习惯、无餐前洗手习惯、非母乳喂养、有RVE患儿接触史、平均每天户外活动时间≤1h、无RV疫苗接种史、处于冬春季以及25(OH)D<35.5μg/L,均是RVE发生的独立危险因素(χ²/t值分别为5.922、24.583、5.125、11.750、4.322、12.670、11.705、14.374,均P<0.05).受试者工作特征(ROC)曲线评估列线图预测儿童RVE发病情况的曲线下面积(AUC)显示,训练集为0.924(95%CI:0.890~0.951)、验证集为0.912(95%CI:0.865~0.998);决策曲线分析法(DCA)曲线显示阈值概率在1%~91%时,净获益率>0。结论 本地区儿童RVE全年均可发病,多见于冬春季.有吮指习惯、无餐前洗手习惯、非母乳喂养、有RVE患儿接触史、平均每天户外活动时间≤1h、无RV疫苗接种史、处于冬春季以及25(OH)D<35.5μg/L均是RVE发生的独立危险因素.基于上述危险因素构建的列线图模型对儿童RVE发病情况具有较高的预测价值.临床应继续加强防控工作,重点保护易感者.

Abstract

Objective To investigate the seasonal distribution characteristics and prevention strategies of rotavirus enteritis (RVE) in children. Methods Children with diarrhoea (246 cases) admitted to our hospital from January 2020 to December 2022 were selected as study subjects and included in the training set; they were divided into the RVE group (132 cases) and the non-RVE group (114 cases) according to the results of RV antigen detection. Another selection of children with diarrhoea (82 cases) were included in the validation set according to the same criteria. The clinical data of the children were collected, the distribution of RVE onset season and month were analysed, and the clinical data and biochemical indexes of the children in the two groups were compared. Risk factors were analysed using multifactorial logistic regression, and a nomogram model was constructed and evaluated. Results In this region, RVE was most common in winter and spring, with a high incidence of RVE from December to the following March, and its incidence accounts for 59.09% of the year. Finger-sucking habit, no preprandial hand-washing habit, non-breastfeeding, history of exposure to children with RVE, average daily outdoor activity time ≤1h, no history of RV vaccination, during winter and spring, and 25(OH)D<35.5μg/L were independent risk factors for the occurrence of RVE (χ²/t=5.922, 24.583, 5.125, 11.750, 4.322, 12.670, 11.705, and 14.374, respectively, all P<0.05). The area under the curve (AUC) of receiver operating characteristic (ROC) curves evaluation nomogram prediction model for predicting the incidence of RVE in children showed 0.924 (95%CI: 0.890-0.951) for the training set and 0.912 (95%CI: 0.865-0.998) for the validation set; and the decision curve analysis (DCA) showed a net benefit rate was >0 for threshold probabilities ranging from 1% to 91%. Conclusion RVE in children in this region can occur throughout the year, mostly in winter and spring. Finger-sucking habits, lack of hand-washing before meals, non-breastfeeding, history of exposure to children with RVE, average outdoor activity time ≤1h, no history of RV vaccination, during winter and spring, and 25(OH)D<35.5μg/L were all independent risk factors for the development of RVE. The nomogram model constructed on the basis of the above risk factors had a high predictive value for the incidence of RVE in children. Clinical efforts should continue to be strengthened to prevent and control RVE, focusing on the protection of susceptible individuals.

关键词

儿童 / 轮状病毒 / 肠炎 / 预防策略

Key words

children / rotavirus / enteritis / prevention strategy

参考文献

[1] Myat T W, Thu H H, Tate J E, et al. Rotavirus infection among children under five years of age hospitalized with acute gastroenteritis in Myanmar during 2018-2020-multicentre surveillance before rotavirus vaccine introduction[J]. Vaccine, 2021, 39(47): 6907-6912.

[2] Lestari F B, Vongpunsawad S, Wanlapakorn N, et al. Rotavirus infection in children in Southeast Asia 2008-2018: disease burden, genotype distribution, seasonality, and vaccination[J]. J Biomed Sci, 2020, 27(1): 66.

[3] Omatola C A, Olaniran A O. Rotaviruses: from pathogenesis to disease control-a critical review[J]. Viruses, 2022, 14(5): 875.

[4] 贾伟, 杨东, 解俊章, 等. 儿童轮状病毒肠炎在腹泻病例中的构成比及危险因素分析[J]. 国际病毒学杂志, 2022, 29(4): 330-333.

[5] 胡淑莹, 王利莹, 李明磊, 等. 小儿轮状病毒肠炎并发惊厥的影响因素分析[J]. 中国全科医学, 2021, 24(11): 1344-1348.

[6] Donato C M, Roczo-Farkas S, Kirkwood C D, et al. Rotavirus disease and genotype diversity in older children and adults in Australia[J]. J Infect Dis, 2022, 225(12): 2116-2126.

[7] National Health Commission, National Administration of Traditional Chinese Medicine. / 国家卫生健康委员会, 国家中医药管理局. 儿童急性感染性腹泻病诊疗规范(2020年版)[J]. 传染病信息, 2021, 34(1): 7-14.

[8] 黄智顺, 谢孙玮, 杨大练, 等. 中山市南朗镇小儿轮状病毒性肠炎流行特点及防治策略分析[J]. 中外医学研究, 2021, 19(4): 159-161.

[9] 王向辉. 2017-2020年郑州某儿童医院轮状病毒肠炎流行病学特征及影响因素分析[J]. 预防医学论坛, 2021, 27(11): 868-870.

[10] 蔡威, 陈金友, 陈坤. 杭州市某医院轮状病毒性肠炎流行特征分析[J]. 预防医学, 2018, 30(8): 825-826, 829.

[11] 王亚利, 田娟, 郭斌. 渭南市临渭区学龄前期儿童轮状病毒感染性腹泻流行特征调查研究[J]. 解放军预防医学杂志, 2018, 36(10): 1235-1237.

[12] 左洪, 漆赛男, 龚江文. 100例儿童轮状病毒性肠炎的临床特征及流行病学分析[J]. 江西医药, 2022, 57(11): 2016-2018.

[13] Lee C. Controversial effects of vitamin D and related genes on viral infections, pathogenesis, and treatment outcomes[J]. Nutrients, 2020, 12(4): 962.

[14] 马汉伟, 张妮, 李元枭. 维生素D与轮状病毒肠炎的相关研究进展[J]. 中国临床研究, 2020, 33(10): 1425-1427, 1431.

[15] Zhao Y, Ran Z, Jiang Q, et al. Vitamin D alleviates rotavirus infection through a microrna-155-5p mediated regulation of the TBK1/IRF3 signaling pathway in vivo and in vitro[J]. Int J Mol Sci, 2019, 20(14): 3562.

[16] 陈琼, 梅红, 高源, 等. 轮状病毒性肠炎患儿血清1,25-(OH)₂D₃、INF-γ、CD11b水平变化及意义 [J]. 山东医药, 2021, 61(31): 26-29.

[17] Jiang S, Fang J, Yu T, et al. Novel model predicts diabetic nephropathy in type 2 diabetes[J]. Am J Nephrol, 2020, 51(2): 130-138.