CAJ | 학술논문

目的分析本院2009年夏季手足口病患儿病原及其血清型特征,为临床早期诊断和疾病防控提供实验依据.方法 2009年4-9月,首都儿科研究所附属儿童医院门诊就诊的174例手足口病患儿咽拭子和疱疹液,实时荧光RT-PCR方法检测肠道病毒通用型(EV)、柯萨奇A16型(CA16)、肠道病毒71型(EV71).131例患儿双份血清,同时检测CA16、EV71 IgM抗体.CA16和EV71阳性标本扩增VP1区基因片段后测序,进行同源性和系统进化分析.结果 (1) EV、CA16、EV71阳性例数分别为167、112、46;阳性率为96.0％、64.4％、26.4％,CA16:EV71为2.43:1.(2)首诊血清CA16和EV71 IgM阳性例数为51、25,阳性率为38.9％、19.1％,复诊阳性例数为98、32,阳性率为74.8％、24.4％.(3) CA16 VP1区核苷酸同源性为88.7％～ 98.5％,EV71 VP1区核苷酸同源性为94.9％～99.7％,与CA亚型参比序列核苷酸同源性92.1％～95.3％.结论 2009年夏季本院手足口病患儿病原以CA16、EV71为主,EV71阳性率较之前报道有较大幅度升高.EV71病毒株以C4亚型为主.实时RT-PCR法较血清学检测特异性IgM抗体更适于疾病早期诊断.
목적 분석본원2009년하계수족구병환인병원급기혈청형특정,위림상조기진단화질병방공제공실험의거.방법 2009년4-9월,수도인과연구소부속인동의원문진취진적174례수족구병환인인식자화포진액,실시형광RT-PCR방법검측장도병독통용형(EV)、가살기A16형(CA16)、장도병독71형(EV71).131례환인쌍빈혈청,동시검측CA16、EV71 IgM항체.CA16화EV71양성표본확증VP1구기인편단후측서,진행동원성화계통진화분석.결과 (1) EV、CA16、EV71양성례수분별위167、112、46;양성솔위96.0％、64.4％、26.4％,CA16:EV71위2.43:1.(2)수진혈청CA16화EV71 IgM양성례수위51、25,양성솔위38.9％、19.1％,복진양성례수위98、32,양성솔위74.8％、24.4％.(3) CA16 VP1구핵감산동원성위88.7％～ 98.5％,EV71 VP1구핵감산동원성위94.9％～99.7％,여CA아형삼비서렬핵감산동원성92.1％～95.3％.결론 2009년하계본원수족구병환인병원이CA16、EV71위주,EV71양성솔교지전보도유교대폭도승고.EV71병독주이C4아형위주.실시RT-PCR법교혈청학검측특이성IgM항체경괄우질병조기진단.
Objective To analyze the pathogen and characteristics of the serum types of enterovirus of hand-foot-and-mouth disease ( HFMD ) in the summer,2009.Methods Both throat swab and herpes fluids were taken respectively from 174 children with HFMD in the outpatient infection during April to September,2009.Anti-Cox A16 and anti-EV71 IgMs in the serum were detected with ELISA.And RNA were extracted from each sample followed with real-time fluorescence quantitative RT-PCR kits with three reagents:universal enterovirus primer,Coxsackievirus A16 (CA16) primer and enterovirus 71 (EV71)primer.Parts of positive samples were sequenced and analyzed.Results ( 1 ) EV genes were detected from 167 cases,of which,112 cases were positive for CA16 and 46 were positive for EV71.CA16:EV71 was 2.43∶ 1.(2)There were 51 cases with CA16 IgM positive and 25 cases with EV71 IgM positive in the early collected sera,and in the later samples,98 cases with CA16 IgM positive and 32 cases with EV71 IgM positive.(3)The nucleotide homologies were 88.7％-98.5％ of VP1 gene among CA16.The nucleotide homologies were 94.9％-99.7％ of VP1 gene among EV71,and were 92.1％-95.3％ with C4 subtype.Conclusion The mainly pathogen causing HFMD in children in the summer,2009 were CA16 and EV71.EV71 infection,mainly C4 subtype,was highly elevated according to the earlier reported.Real-time RT-PCR is more appropriate than the serological test.