The Study Of Humen Bocavirus Epidemiological Characteristics In Children With Acute Respiratory Infections And Pneumonia Diagnosis And Pathognomic Pattern Of TCM

Objective:The aim of this study was to explore epidemiological characteristics of HBoV1 and to evaluate the clinical diagnosis value of C-reactive protein?CRP?in children with pneumonia and the pathognomic pattern.Methods:?1?PCR,RT-PCR and Nested PCR were used to detect HBoV1?HBoVl?and other viruses?RSV,ADV,HRV,IFVA,IFVB,PIV1,PIV2,PIV3,HMPV,NL63 and HKUI?in 2175 children with acute respiratory tract infection,A multivariate logistic regression model was used to explore possibility of co-detected for related viruses.?2?862 children cases with pneumonia in hospitalized were evaluated.All children had serum CRP levels measured.Bacterial identification were performed,PCR,RT-PCR and Nest-PCR was performed to detect respiratory viruses include HBoV1,RSV,ADV,HRV,IFVA,IFVB,PIV1,PIV2,PIV3,HMPV,NL63 and HKUI.A multivariable logistic regression analysis was used with independent?CRP,the proportion of neutrophils?NEUT?,body temperature,sputum production,age,and dyspnea?and dependent variables for clinical diagnosis?severe pneumonia and non-severe pneumonia?.A receiver operating characteristic curve?ROC?was generated using the new variables?Pre-1,Pre-2,and Pre-3?to assess their predictive value for severe pneumonia.?3?258 children cases with pneumonia?including mild pneumonia and severe pneumonia?were included according to modern medicine diagnostic criteria and inclusion criteria and exclusion criteria in this study from September 2009 to July 2012.the relevant information was extracted through surveys of patients,the type of pathognomic pattern were divided into seven kinds such as:Wind-Cold Obstructing the Lung,Wind-Heat Obstructing the Lung,Phlegm-Heat Obstructing the Lung,Yin Asthenia Generating Lung Heat,Cold-Pack-Heat syndrome,Asthenia of Pulmonosplenic Qi,Toxin-Heat Obstructing the Lung of syndromes according to TCM syndrome diagnostic criteria,the signs and symptoms scoring criteria was defined to follew fever,cough,expectoration,shortness of breath and other score,nasopharyngeal secretion samples were collected.PCR,RT-PCR and Nest-PCR were used to detect 12 kinds of major respiratory viruses.Results:?1?The positivity rates in Lanzhou and Nanjing were 11.62%?161/1386?and 9.38%?74/789?,respectively?P>0.05?.The HBoV1 positive group was younger than negative group?P<0.05?.However,seasonal differences in HBoV1 were noted,with a higher frequency of infection in December and July.A majority of the HBoVl-positive children[72.34%?169/235?]were co-detected with other respiratory viruses.Multifactorial logistic regression analysis showed no correlations between HBoV1 and the clinical diagnostic classification,region,gender,age,or treatment as an outpatient or in a hospital.It was also detected correlations between HBoV1-DNA positive with ADV?odds ratio[OR]= 1.53,95%confidence interval[CI]1.03-2.28?,RSV?OR = 0.71,95%CI 0.52-0.98?and IFVA?OR = 1.77,95%CI = 1.00-3.13?.?2?In the 862 patients,108 cases?24.13%?had severe pneumonia and 754 cases?75.87%?were non-severe pneumonia.Increased CRP levels were correlated with severe pneumonia and bacterial infection?P<0.05?.A multivariate logistic regression analysis found that severe pneumonia was associated with CRP levels,body temperature,expectoration,age,NEUT,and shortness of breath?P<0.05?.The ROC of the regression diagnostics model sequentially presented CRP,CRP and the other five correlative variables,the other five correlative variables used to diagnose severe pneumonia,and the area under curve?AUC?,respectively,for Pre-1 0.550[95%CI 0.490-0.609],Pre-2 0.897[95%CI 0.861-0.932],and Pre-3 0.893[95%CI 0.855-0.931].The results showed that the six correlative variables had better accuracy in the diagnosis of severe pneumonia according to the Youden index maximum.?3?Median age of 258 cases in children with pneumonia was 48 months,the ratio of male to female was 1.77:1.There were 166 cases detected one virus of the 12 kinds of major respiratory viruses,kinds of virus distribution was statistically significantbetween different pathognomic pattern?P<0.00?.258 cases in children with pneumonia classified as follows Wind-Cold Obstructing the Lung in 23 cases?8.91%?,Wind-Obstructing the Lung in 89 cases?34.50%?,Phlegm-Heat Obstructing the Lung in 122 cases?47.29%?,Yin Asthenia Generating Lung Heat in 4 cases?1.55%?,Cold-Pack-Heat syndrome in 5 cases?1.94%?,Asthenia of Pulmonosplenic Qi in 7 cases?2.71%?,Toxin-Heat Obstructing the Lung in 8 cases?3.10%?.Pathognomic pattern distribution was statistically significant between different seasons and age groups in children with pneumonia?P<0.05?.There was a correlation between pathognomic pattern distribution and age groups?P<0.05?;but gender group was not statistically significant.Moderate fever proportion?47.29%?was higher in 258 cases,the distribution of fever,cough in children with pneumonia were statistically significant?P<0.01?.Shortness of breath had not been found in 58₉1%children patients,27.13%children with pneumonia after activities appeared shortness of breath,10.88%children appeared shortness of breath in a quiet time,and 3.10%children need oxygen.The distribution of shortness of breath between Cold-Pack-Heat syndrome and Toxin-Heat Obstructing the Lung and others pathognomic pattern were statistically significant?P<0.05?.258 cases in children with pneumonia detected 11 kinds respiratory viruses establish discriminant function and seven kinds of syndromes.RSV,HRV and HBoV1 may had impacted discriminate of pneumonia syndrome type?P<0.05?.there were closely related between RSV and Asthenia of Pulmonosplenic Qi,Toxin-Heat Obstructing the Lung,Wind-Cold Obstructing the Lung and Cold-Pack-Heat syndrome,there were closely related between HRV and Asthenia of Pulmonosplenic Qi,Wind-Heat Obstructing the Lung,there were closely related between HBoV1 and Asthenia of Pulmonosplenic Qi,Yin Asthenia Generating Lung Heat and Cold-Pack-Heat syndrome.Conclusions:?1?HBoV1 were mainly detected in the 6 months to 6 years old children with acute respiratory infections,the virus was likely to be one of the main causes of this age children.Presence of HBoVl-DNA in nasopharyngeal aspirates was not correlated with region or gender.Co-infections were higher in children with acute respiratory infections?about 70%?.Probably there were synergistic effect between HBoV1 and ADV and IFVA.Disease status in children with respiratory tract infections may be associated with ages and respiratory viruses such as RSV,NL63 and PIV3.?2?CRP serum levels were closely related to bacterial infections and severe pneumonia.CRP,along with other parameters,could be used as early indicators of severe pneumonia development.However,the usefulness of CRP alone to diagnose severe pneumonia was limited.?3?There were more excess pathognomic pattern such as Phlegm-Heat Obstructing the Lung,Wind-Heat Obstructing the Lung and Wind-Cold Obstructing the Lung in 258 children with pneumonia.Small proportion with asthenia of Pulmonosplenic Qi and Toxin-Heat Obstructing the Lung,Pathognomic pattern distribution was statistically significant between different seasons and age groups in children with pneumonia,distribution of fever,sputum,and shortness of breath were statistically significant in patients with pneumonia episodes.RSV,HRV and HBoV1 may had impacted discriminate of pneumonia syndrome type?P<0.05?.