中华预防医学杂志
中華預防醫學雜誌
중화예방의학잡지
CHINESE JOURNAL OF
2012年
10期
883-887
,共5页
黄学勇%康锴%许玉玲%卫海燕%李幸乐%马宏%尤爱国%陈豪敏%许汴利
黃學勇%康鍇%許玉玲%衛海燕%李倖樂%馬宏%尤愛國%陳豪敏%許汴利
황학용%강개%허옥령%위해연%리행악%마굉%우애국%진호민%허변리
手足口病%肠道病毒感染%柯萨奇病毒感染
手足口病%腸道病毒感染%柯薩奇病毒感染
수족구병%장도병독감염%가살기병독감염
Hand,foot and mouth disease%Enterovirus infections%Coxsackievirus infections
目的 了解2008-2011年河南省手足口病(HFMD)的病原体型别及分布特征.方法 于2008-2011年收集河南省各市级CDC门诊就诊和住院的30 486例HFMD患儿的粪便、肛拭子或咽拭子标本,共30 486份.采用RT-PCR、实时荧光RT-PCR法对河南省临床诊断HFMD患者标本进行肠道病毒71型(EV71)、柯萨奇病毒A组16型(CA16)和其他肠道病毒核酸检测及病毒分离鉴定；扩增EV71分离株VP1区基因并测定序列,利用生物信息学软件分析序列,构建序列遗传进化树.结果 30 486例患者中实验室诊断17 876例,EV71、CA16和其他肠道病毒阳性率分别为62.70％(11209/17 876)、12.03％(2150/17 876)、25.27％(4517/17 876),差异有统计学意义(x2=157.17,P ＜0.05).男性EV71、CA16、其他肠道病毒阳性率分别为63.40％ (7370/11 624)、11.58％(1346/11 624)、25.02％ (2908/11 624)；女性分别为61.40％ (3839/6252)、12.86％ (804/6252)、25.74％(1609/6252),性别间差异有统计学意义(x2=4.06,P＜0.05).5岁以下儿童为HFMD的高危人群,占实验室诊断病例的97.67％(17 459/17 876)；其中1～3岁儿童患者最多,占诊断病例的86.92％( 15 537/17 876).EV71构成比随季节而发生变化,4-6月份较高,5月份高达69.34％(2384/3438).实验室诊断6929例重症患者中的82.48％( 5715/6929)为EV71感染,1.76％( 122/6929)为CA16感染,15.76％ (1092/6929)为其他肠道病毒感染,EV71感染率明显高于CA16和其他肠道病毒(x2值分别为9259.17、6170.81,P值均＜0.05).重症患者中死亡117例,实验室诊断55例,诊断率为47.01％,以EV71感染为主(50例).遗传进化分析显示,EV71毒株VP1基因属于C基因型的C4亚型.结论 河南省HFMD主要病原是EV71和CA16；EV71病毒为优势流行株,属于C基因型的C4亚型.
目的 瞭解2008-2011年河南省手足口病(HFMD)的病原體型彆及分佈特徵.方法 于2008-2011年收集河南省各市級CDC門診就診和住院的30 486例HFMD患兒的糞便、肛拭子或嚥拭子標本,共30 486份.採用RT-PCR、實時熒光RT-PCR法對河南省臨床診斷HFMD患者標本進行腸道病毒71型(EV71)、柯薩奇病毒A組16型(CA16)和其他腸道病毒覈痠檢測及病毒分離鑒定；擴增EV71分離株VP1區基因併測定序列,利用生物信息學軟件分析序列,構建序列遺傳進化樹.結果 30 486例患者中實驗室診斷17 876例,EV71、CA16和其他腸道病毒暘性率分彆為62.70％(11209/17 876)、12.03％(2150/17 876)、25.27％(4517/17 876),差異有統計學意義(x2=157.17,P ＜0.05).男性EV71、CA16、其他腸道病毒暘性率分彆為63.40％ (7370/11 624)、11.58％(1346/11 624)、25.02％ (2908/11 624)；女性分彆為61.40％ (3839/6252)、12.86％ (804/6252)、25.74％(1609/6252),性彆間差異有統計學意義(x2=4.06,P＜0.05).5歲以下兒童為HFMD的高危人群,佔實驗室診斷病例的97.67％(17 459/17 876)；其中1～3歲兒童患者最多,佔診斷病例的86.92％( 15 537/17 876).EV71構成比隨季節而髮生變化,4-6月份較高,5月份高達69.34％(2384/3438).實驗室診斷6929例重癥患者中的82.48％( 5715/6929)為EV71感染,1.76％( 122/6929)為CA16感染,15.76％ (1092/6929)為其他腸道病毒感染,EV71感染率明顯高于CA16和其他腸道病毒(x2值分彆為9259.17、6170.81,P值均＜0.05).重癥患者中死亡117例,實驗室診斷55例,診斷率為47.01％,以EV71感染為主(50例).遺傳進化分析顯示,EV71毒株VP1基因屬于C基因型的C4亞型.結論 河南省HFMD主要病原是EV71和CA16；EV71病毒為優勢流行株,屬于C基因型的C4亞型.
목적 료해2008-2011년하남성수족구병(HFMD)적병원체형별급분포특정.방법 우2008-2011년수집하남성각시급CDC문진취진화주원적30 486례HFMD환인적분편、항식자혹인식자표본,공30 486빈.채용RT-PCR、실시형광RT-PCR법대하남성림상진단HFMD환자표본진행장도병독71형(EV71)、가살기병독A조16형(CA16)화기타장도병독핵산검측급병독분리감정；확증EV71분리주VP1구기인병측정서렬,이용생물신식학연건분석서렬,구건서렬유전진화수.결과 30 486례환자중실험실진단17 876례,EV71、CA16화기타장도병독양성솔분별위62.70％(11209/17 876)、12.03％(2150/17 876)、25.27％(4517/17 876),차이유통계학의의(x2=157.17,P ＜0.05).남성EV71、CA16、기타장도병독양성솔분별위63.40％ (7370/11 624)、11.58％(1346/11 624)、25.02％ (2908/11 624)；녀성분별위61.40％ (3839/6252)、12.86％ (804/6252)、25.74％(1609/6252),성별간차이유통계학의의(x2=4.06,P＜0.05).5세이하인동위HFMD적고위인군,점실험실진단병례적97.67％(17 459/17 876)；기중1～3세인동환자최다,점진단병례적86.92％( 15 537/17 876).EV71구성비수계절이발생변화,4-6월빈교고,5월빈고체69.34％(2384/3438).실험실진단6929례중증환자중적82.48％( 5715/6929)위EV71감염,1.76％( 122/6929)위CA16감염,15.76％ (1092/6929)위기타장도병독감염,EV71감염솔명현고우CA16화기타장도병독(x2치분별위9259.17、6170.81,P치균＜0.05).중증환자중사망117례,실험실진단55례,진단솔위47.01％,이EV71감염위주(50례).유전진화분석현시,EV71독주VP1기인속우C기인형적C4아형.결론 하남성HFMD주요병원시EV71화CA16；EV71병독위우세류행주,속우C기인형적C4아형.
Objective To understand etiological types and distribution features of hand-foot-mouth disease (HFMD) in Henan province between 2008 and 2011.Methods A total of 30 486 specimens of feces,rectal swabs or throat swabs from HFMD patients were collected by each Municipal CDC in Henan from 2008 to 2011.The enterovirus 71 ( EV71 ),coxsackie virus A16 (CA16) and other enterovirus (EV) were detected by RT-PCR or real time RT-PCR.The VP1 gene of EV71 was amplified and the sequences were analyzed by bioinformatics software.A genetic evolution tree of the sequence was constructed as well.Results The positive rates of EV71,CA16 and other EV were 62.70％ ( 11 209/17 876),12.03％(2150/17 876),25.27％ (4517/17 876)in 17 876 laboratory diagnosed cases,respectively.The differences were statistically significant (x2 =157.17,P ＜0.05).The positive rates of EV71,CA16 and other EV were 63.40％ (7370/11 624 ),11.58％ ( 1346/11 624 ) and 25.02％ ( 2908/11 624 ) in male patients and 61.40％ ( 3839/6252 ),12.86％ ( 804/6252 ) and 25.74％ ( 1609/6252 ) in female patients,respectively.The differences were statistically significant (x2 =4.06,P ＜ 0.05 ).The children under 5 years old were high-risk population of HFMD,accounting to 97.67％ ( 17 459/17 876) of the laboratory-diagnosed patients.86.92％ ( 15 537/17 876)cases were children between 1 to 3 years old.Constituent ratio of EV71 changed seasonally during a year,there was a high infection ratio of EV71 between April and June,especially in May,the infection ratio reached 69.34％ (2384/3438).The positive rates of EV71,CA16 and other EV were 82.48％ ( 5715/6929 ),1.76％ ( 122/6929 ) and 15.76％ ( 1092/6929 ) among the 6929 laboratory-diagnosed severe cases,respectively.The positive rates of EV71 was higher than CA16 and other EV(x2 =9259.17,6170.81,P ＜0.05,respectively).There were 117 deaths because of severe HFMD,55 (47.01％ ) of which were laboratory confirmed.50 death cases were infected by EV71,and according to the genetic evolution analysis,the VP1 gene of EV71 strain was belonged to subtype C4 of gene C.Conclusion The EV71 and CA16 were the main pathogens which caused HFMD in Henan province,and EV71 virus was the dominant strain,belonging to C4 subtype of gene C.
