调查2009~2010年上海地区人群急性呼吸道感染（ARTI）的病毒性病原，探讨新型甲型H1N1流感暴发背景下呼吸道感染病毒病原谱的构成。采用套式多重反转录-聚合酶链反应（RT- PCR）和实时荧光定量RT- PCR方法，对来自2 044例患者的2 044份标本（包括2 005份鼻咽拭子和39份肺泡灌洗液）同时检测腺病毒(ADV)、副流感病毒(PIV)、A型流感病毒(FluA)、B型流感病毒( FluB)、微小核糖核酸病毒、呼吸道合胞病毒(RSV)、人偏肺病毒（hMPV）、人冠状病毒(CoV)和人博卡病毒（BoV）。其中，656 (32.09%)份标本经呼吸道病毒检测为阳性，52份标本为双重感染。FluA检出率最高（13.36%），其次依次为微小核糖核酸病毒（10.23%）、FluB（4.84%）、ADV（1.96%）、PIV（1.76%）、RSV（1.32%）、CoV（0.59%）、hMPV（0.39%）和BoV（0.20%）。但各月病毒检出率分布不均，2009和2010呼吸道病毒检出率高峰出现在当年11月（53.07%和65.59%），低谷都出现在当年5月，且2009年5~9月的病毒检出率高于2010年同期（32.08% vs 15.38%，P<0.05）。其中，新型甲型H1N1流感暴发导致2009年10月~2010年1月该病毒占当月检出FluA的100%，2009年6~9月也占当月检出FluA的较高比率，依次为90.91%（20/22）、75.00%（15/20）、48.00%（12/25）和56.25%（18/32）。甲型H3N2流感病毒和新型甲型H1N1流感病毒分别在URTI和LRTI的检出率比较，无统计学差异(URTI, 85.29% vs 76.61%；LRTI, 14.71% vs 23.39%；P>0.05)。呼吸道病毒检出率还与年龄相关，0~4岁组和5~14岁组病毒检出率高于其他年龄组，在0~4岁及≥65岁组中微小核糖核酸病毒检出率最高，FluA次之；其余年龄组中FluA检出率最高。混合感染中15岁以下儿童占50%(26/52)，微小核糖核酸病毒和其他病毒混合感染占84.62%（44/52）。本研究表明，2009~2010年FluA是最常见的急性呼吸道感染病原，新型甲型H1N1流感病毒成为上海地区2009年FluA的优势亚型。微小核糖核酸病毒是混合感染最常见的病原。结果提示，我们应长期监测主要呼吸道病毒的活动水平，并加强对微小核糖核酸病毒流行病学和致病性的研究。

The present paper aims to understand the viral etiology in patients with acute respiratory tract infection (ARTI) in Shanghai area during 2009-2010, and explore the respiratory viral spectrum under the background of 2009 A(H1N1) influenza outbreak worldwide. A total of 2 005 nasopharyngeal swab and 39 lavage fluid specimens from 2 044 patients were analyzed by nested multiplex reverse transcriptase-polymerase chain reaction (RT-PCR) and real-time quantitative RT-PCR for detection of common respiratory viruses, including adenovirus (ADV), parainfluenza virus (PIV), influenza virus A (FluA), influenza virus B (FluB), picornavirus, respiratory syncytial virus (RSV), human metapneumovirus (hMPV), coronavirus (CoV) and Boca virus (BoV). The results showed that 656 out of 2 044 specimens (32.09%) were positive for one or more viruses, 52 specimens were positive for two viruses. FluA (13.36%) was the dominant agent detected, followed by picornavirus (10.23%), FluB (4.84%), ADV (1.96%), PIV (1.76%), RSV (1.32%), CoV (0.59%), hMPV (0.39%), and BoV (0.20%). The viral detection rates changed regularly within the two years. The peak of detection rate appeared in the November and the lowest rate appeared in May within the two year. The viral detection rate of 2009 May to September was significantly higher than the rate in the same period in 2010（32.08% vs 15.38%，P<0.05）.Additionally, the agents in all of FluA-positive specimens were 2009 A(H1N1) influenza virus during October 2009 to January 2010, and the ratio of 2009 A(H1N1) influenza virus in FluA positive-specimens was 90.91%（20/22）, 75.00% (15/20), 48.00% (12/25) and 56.25% (18/32) in June，July, August and September 2009, respectively. The frequency of URTI or LRTI caused by H3N2 or 2009H1N1 was similar(URTI, 85.29% vs 76.61%；LRTI, 14.71% vs 23.39%；P>0.05). The viral detection rate was related with the age. In 0-4 years group and 5-14 years group, the viral detection rates were higher than those in other groups. Picornavirus was the most commonly detected viral agent in 0-4 years and ≥65 years group, followed by FluA, However, FluA was the dominant virus in other groups. Of the whole co-infection cases, children less than 15 years accounted for 50% (26/52). 44 cases (84.62%) were infected with picornavirus combining with other respiratory virus. Our study suggests that FluA is the most common respiratory virus in ARTI in Shanghai area during 2009-2010. 2009 A(H1N1) influenza virus becomes the dominant FluA subtype during its two waves of outbreak. Picornavirus is the most common pathogen in co-infection cases. We should pay constantly attention to the respiratory virus monitoring and explore the clinical significance and biological properties of picornavirus.