兒童急性呼吸道感染是造成兒童住院治療的主要原因之一，而造成急性呼吸道感染的主要因素為病毒性感染，在兒童病毒性肺炎中，腺病毒是僅次於呼吸道融合性病毒的致病原。兒童腺病毒感染具有廣範的流行性，可以表現較嚴重且多樣的感染症狀，例如較長的發燒期、較嚴重的病容。在病患血液檢查方面，呈現白血球增多、發炎指數上升，與其它病毒的比較下，不易與細菌性感染在臨床症狀與實驗數值上作區別。由於兒科病患中，腺病毒佔有很高的感染比例，但因治療上易與細菌之感染混淆，容易增加抗生素的使用及延長了住院天數，增加醫療費用的支出，因此快速且正確的診斷腺病毒感染乃有其必要性。並且在流行病學上，腺病毒的亞屬（subgenus）及血清型（serotypes）分型的確認，可以了解疾病傳播腺病毒之間的關係，於公共衛生調查及疾病防治方面，提供線索以確認病因。
在本研究中利用聚合酶連鎖反應結合基因序列分析方法，將台中榮民總醫院病毒室自1999年至2002年呼吸道腺病毒分離株472例中依年份隨機抽取194例進行型別分析，型別確立後與臨床病例比對找出疾病與各型別間的相關性，結果顯示在1999年至2002年中部地區兒童呼吸道腺病毒感染是以亞屬B為多數，佔70.6%，亞屬C佔23.1%，亞屬E只佔6.1%，在血清型方面，則以第三型（47.9%），第七型（12.4%）為主要分離株，在研究中發現呼吸道腺病毒感染以男童較多（1.66：1），並以3~6歲時為感染高峰，之後隨年齡上升而降低，呼吸道腺病毒感染除造成一般感冒的症狀外，也造成支氣管炎及肺炎（27.1%）等嚴重疾病，尤其以血清型第三型為最強的致病源。在兒童病毒性感染，治療方面主要為支持性療法，但若是具備某些危險因子，如先天性心臟病、免疫功能不全等，則可給予Ribavirin 治療，以改善預後。在研究期間另發現有2例心肌炎、2例先天性心臟病、1例腦膜炎、1例急性淋巴性白血病，皆遭受血清型第三型感染。所以快速診斷腺病毒及血清型，可以幫助臨床醫師對病情的診斷及預後的參考。

Serotypes of Adenovirus and the incidence study in mid-Taiwan
The most important disease of the admission children patient is acute respiratory infectious disease. The most important pathologies of that infection are viral infection especial respiratory syncytial virus (RSV) and adenovirus. The presentation of the child adenoviral infection showed variable clinical presentations such as long tern fever course, leukocytosis and high level of C-reaction protein. It’s difficult to different adenovirus infection and ordinary bacterial respiratory infection. Early diagnosis of the bacterial or viral infection is necessary for the treatment of the infection such as use of the antibiotic or prediction of hospital course. Otherwise, to identify the serotypes and subgenus of adenovirus may understand the clinical pandemic or endemic condition of the adenoviral infection in children.
Depending on the serotype, there are considerable differences in the tissue specificity and virulence of adenoviruses. The different outcomes of adenovirus infections are not very well understood, for example, why the infection is self-limiting in some individuals and becomes persistent in others. In this study, we applied the method of polymerase primer reaction (PCR) with gene sequence analysis to identify the adenovirus cultured by viral laboratory of Taichung Veteran General Hospital from 1999 to 2002. There were 194 adenovirus to test in this study that virus took randomly from the total amount of 472 in that hospital. The clinical presentations and the diagnosis of these adenovirus infection children were recorded for further analysis. In our study, the major subgenus type of the adenovirus in mid-Taiwan during 1999 to 2002 is subgenus B. The percent of each subgenus were B 70.6%, C 23.1% and E 6.1%. The serotypes of type 3 (47.9%) and type 7 (12.4%) play the major roles of the serotype study. The ratio of the male and female children showed 1.66/1 and the peak of incidence of the age were the period of 3 to 6 year old. Adenovirus can cause serious disease including bronchopneumonia, pneumonia, carditis, nephritis, and encephalitis. Serotype 3 of the adenovirus play the most importance role in children of severe adenoviral infection. We collected 2 cases of carditis, 2 cases of congenital heart defect, 1 case of meningitis, 1 case of acute lymphoid leukemia with adenovirus infection in the study. All of then infected by serotype 3 adenovirus. Although the treatment of the adenovirus is supportive treatment, we could administrate ribavirin in the immunocompromised host with adenovirus infection. So, early identify viral respiratory infection disease and detect the viral type are important for the clinical physician to diagnosis.

目錄
圖目錄-------------------------------------------------------------------V
表目錄-------------------------------------------------------------------VII
中文摘要----------------------------------------------------------------1
壹、 前言--------------------------------------------------------------3
貳、 文獻探討--------------------------------------------------------5
參、 材料與方法---------------------------------------------------19
肆、 結果------------------------------------------------------------42
伍、 討論------------------------------------------------------------74
陸、 結論------------------------------------------------------------82
參考文獻--------------------------------------------------------------83
英文摘要--------------------------------------------------------------97

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