CAJ | 학술논문

目的：了解2013年杭州市手足口病（ HFMD）流行特征、不同HFMD病原体与疾病严重程度关系以及人肠道病毒71型（ HEV71）阳性重症HFMD患儿接触人群HEV71携带率。方法：采集2013年杭州市儿童医院收治的HFMD疑似患儿咽拭子或粪便标本，采用实时荧光定量PCR检测HFMD病原体，了解轻症和重症HFMD患儿中HFMD病原体的分布。选取54例HEV71阳性重症HFMD患儿家属中密切接触和一般接触者各1名，检测其粪便标本中的HEV71并随访1个月。分析杭州市儿童医院2011～2013年检出的HFMD病原体构成比差异和优势病原体转变。结果：849例HFMD疑似患儿中确诊641例，男女患儿比例1．4∶1，1～3岁患儿占80．3％。 HFMD患儿标本中24．3％（156/641）检出HEV71，4．7％（30/641）检出A组16型柯萨奇病毒（CVA16），71．0％（455/641）检出其他肠道病毒。75．6％（118/156）HEV71感染病例为重症HFMD，但CVA16和其他HFMD病毒感染病例中仅分别有13．3％（4/30）和6．2％（28/455）为重症HFMD，三者间差异有统计学意义（χ2＝43．28， P ＜0．05）。2011、2012年 HFMD 优势病原体为HEV71，2013年为其他肠道病毒。54例密切接触者和54例一般接触者中分别有9例和10例检出HEV71（ P＞0．05），且均无HFMD临床表现。结论：2013年杭州市HFMD流行季节、好发年龄与性别无明显变化，HEV71感染易引发重症HFMD，但其他肠道病毒已替代HEV71成为HFMD优势病原体。
목적：료해2013년항주시수족구병（ HFMD）류행특정、불동HFMD병원체여질병엄중정도관계이급인장도병독71형（ HEV71）양성중증HFMD환인접촉인군HEV71휴대솔。방법：채집2013년항주시인동의원수치적HFMD의사환인인식자혹분편표본，채용실시형광정량PCR검측HFMD병원체，료해경증화중증HFMD환인중HFMD병원체적분포。선취54례HEV71양성중증HFMD환인가속중밀절접촉화일반접촉자각1명，검측기분편표본중적HEV71병수방1개월。분석항주시인동의원2011～2013년검출적HFMD병원체구성비차이화우세병원체전변。결과：849례HFMD의사환인중학진641례，남녀환인비례1．4∶1，1～3세환인점80．3％。 HFMD환인표본중24．3％（156/641）검출HEV71，4．7％（30/641）검출A조16형가살기병독（CVA16），71．0％（455/641）검출기타장도병독。75．6％（118/156）HEV71감염병례위중증HFMD，단CVA16화기타HFMD병독감염병례중부분별유13．3％（4/30）화6．2％（28/455）위중증HFMD，삼자간차이유통계학의의（χ2＝43．28， P ＜0．05）。2011、2012년 HFMD 우세병원체위HEV71，2013년위기타장도병독。54례밀절접촉자화54례일반접촉자중분별유9례화10례검출HEV71（ P＞0．05），차균무HFMD림상표현。결론：2013년항주시HFMD류행계절、호발년령여성별무명현변화，HEV71감염역인발중증HFMD，단기타장도병독이체대HEV71성위HFMD우세병원체。
Objective: To investigate the epidemic characteristics of hand-foot-and-mouth disease ( HFMD ) in children and exposed population in Hangzhou city . Methods: The throat swab or stool samples from children with HFMD admitted in Hangzhou Children′s Hospital were collected .The HFMD pathogens were detected by real-time fluorescent quantitative PCR .The distribution of different HFMD pathogens in HFMD patients was subsequently determined .Human enteric virus type-71 ( HEV71 ) in stool samples from subjects , who had close or general contact to 54 severe HFMD children with positive HEV 71 , was detected , and these contact persons were followed-up for one month .The diversity of predominant pathogens of HFMD in the area during 2011-2013 was investigated.Results: In 641 HFMD children, the male/female ratio was 1.4∶1 and 80.3% was 1-3 years old.HEV71 was detected in 24.3% HFMD children ( 156/641 ) , while coxakievirus group-A type-16 ( CVA16 ) and other enteroviruses were detected in 4.7%(30/641) and 71.0%(455/641) of the cases, respectively .75 .6% ( 118/156 ) of HEV71-infected cases were diagnosed as severe HFMD cases, while those for CVA16-infected and other HFMD viruses-infected were 13.3%(4/30) and 6.2%(28/455) respectively (χ2 =43.28, P<0.05).HEV71 was the predominant HFMD pathogens during 2011-2012 , while the predominant HFMD pathogens in 2013 were the other HFMD viruses .In the 54 close contact persons or 54 general contact persons , 9 or 10 persons were detectable for HEV 71 , but no clinical symptoms of HFMD were presented .Conclusion: There are no marked changes of epidemic seasons , favorable age and gender ratio of HFMD in Hangzhou area in 2013 . The infection of HEV71 tends to cause the severe HFMD but the other enteroviruses have substituted HEV 71 as the predominant pathogens of HFMD .