中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
35期
4213-4216
,共4页
韩江涛%彭伟%刘立%张世勇%郭建花
韓江濤%彭偉%劉立%張世勇%郭建花
한강도%팽위%류립%장세용%곽건화
手足口病%病原%人类肠道病毒71%柯萨奇病毒A16%石家庄
手足口病%病原%人類腸道病毒71%柯薩奇病毒A16%石傢莊
수족구병%병원%인류장도병독71%가살기병독A16%석가장
Hand,foot and mouth disease%Noxae%Human enterovirus 71%Coxsackievirus A16%Shijiazhuang
目的:分析2009—2012年石家庄市手足口病( HFMD)病原体分布特征及规律。方法选择石家庄市2009—2012年临床诊断为HFMD的部分普通及所有聚集发病、重症和死亡病例,采集病例咽拭子、肛拭子或疱疹液、便等生物学标本进行病原学检测。结合地理信息系统( GIS)对监测数据进行空间分布分析。结果4年共采集3842例HFMD病例生物学标本,阳性检出率为69.29%(2662例)。其中人类肠道病毒71型(EV71)、柯萨奇病毒(Cox) A16和其他肠道病毒比例分别占50.60%(1347例)、35.05%(933例)和14.35%(382例)。2009—2012年,石家庄市各年份HFMD病原学构成间差异有统计学意义(χ2=2.367,P<0.001);其中2009年以CoxA16流行为主(占56.46%),2010、2011年以EV71流行为主(占77.34%、57.51%),2012年再次以CoxA16流行为主(占66.40%)。4年中各型病原在4或5月阳性检出数最高,6月开始迅速下降。CoxA16基本呈单峰变化,而EV71后期会再次增多,呈现“拖尾”现象;其他肠道病毒检出例数较少,时间分布特征不明显。同一流行年各县区病原分布存在地区差异;0~岁儿童较易感染EV71;EV71感染者中重症病例所占比例明显高于普通病例,死亡病例均由EV71感染引起。结论石家庄市近4年来HFMD病原学构成有变化,呈现CoxA16与EV71交替成为优势病原的现象。EV71、CoxA16及其他肠道病毒分别呈现多峰、单峰和不显著峰的时间分布特征。在同一流行年,多数县区的优势病原与全市一致,个别县区的优势病原与全市不一致。随着年龄增长, EV71阳性检出构成比逐渐降低, CoxA16阳性检出构成比逐渐增多,其他肠道病毒构成比变化不大。
目的:分析2009—2012年石傢莊市手足口病( HFMD)病原體分佈特徵及規律。方法選擇石傢莊市2009—2012年臨床診斷為HFMD的部分普通及所有聚集髮病、重癥和死亡病例,採集病例嚥拭子、肛拭子或皰疹液、便等生物學標本進行病原學檢測。結閤地理信息繫統( GIS)對鑑測數據進行空間分佈分析。結果4年共採集3842例HFMD病例生物學標本,暘性檢齣率為69.29%(2662例)。其中人類腸道病毒71型(EV71)、柯薩奇病毒(Cox) A16和其他腸道病毒比例分彆佔50.60%(1347例)、35.05%(933例)和14.35%(382例)。2009—2012年,石傢莊市各年份HFMD病原學構成間差異有統計學意義(χ2=2.367,P<0.001);其中2009年以CoxA16流行為主(佔56.46%),2010、2011年以EV71流行為主(佔77.34%、57.51%),2012年再次以CoxA16流行為主(佔66.40%)。4年中各型病原在4或5月暘性檢齣數最高,6月開始迅速下降。CoxA16基本呈單峰變化,而EV71後期會再次增多,呈現“拖尾”現象;其他腸道病毒檢齣例數較少,時間分佈特徵不明顯。同一流行年各縣區病原分佈存在地區差異;0~歲兒童較易感染EV71;EV71感染者中重癥病例所佔比例明顯高于普通病例,死亡病例均由EV71感染引起。結論石傢莊市近4年來HFMD病原學構成有變化,呈現CoxA16與EV71交替成為優勢病原的現象。EV71、CoxA16及其他腸道病毒分彆呈現多峰、單峰和不顯著峰的時間分佈特徵。在同一流行年,多數縣區的優勢病原與全市一緻,箇彆縣區的優勢病原與全市不一緻。隨著年齡增長, EV71暘性檢齣構成比逐漸降低, CoxA16暘性檢齣構成比逐漸增多,其他腸道病毒構成比變化不大。
목적:분석2009—2012년석가장시수족구병( HFMD)병원체분포특정급규률。방법선택석가장시2009—2012년림상진단위HFMD적부분보통급소유취집발병、중증화사망병례,채집병례인식자、항식자혹포진액、편등생물학표본진행병원학검측。결합지리신식계통( GIS)대감측수거진행공간분포분석。결과4년공채집3842례HFMD병례생물학표본,양성검출솔위69.29%(2662례)。기중인류장도병독71형(EV71)、가살기병독(Cox) A16화기타장도병독비례분별점50.60%(1347례)、35.05%(933례)화14.35%(382례)。2009—2012년,석가장시각년빈HFMD병원학구성간차이유통계학의의(χ2=2.367,P<0.001);기중2009년이CoxA16류행위주(점56.46%),2010、2011년이EV71류행위주(점77.34%、57.51%),2012년재차이CoxA16류행위주(점66.40%)。4년중각형병원재4혹5월양성검출수최고,6월개시신속하강。CoxA16기본정단봉변화,이EV71후기회재차증다,정현“타미”현상;기타장도병독검출례수교소,시간분포특정불명현。동일류행년각현구병원분포존재지구차이;0~세인동교역감염EV71;EV71감염자중중증병례소점비례명현고우보통병례,사망병례균유EV71감염인기。결론석가장시근4년래HFMD병원학구성유변화,정현CoxA16여EV71교체성위우세병원적현상。EV71、CoxA16급기타장도병독분별정현다봉、단봉화불현저봉적시간분포특정。재동일류행년,다수현구적우세병원여전시일치,개별현구적우세병원여전시불일치。수착년령증장, EV71양성검출구성비축점강저, CoxA16양성검출구성비축점증다,기타장도병독구성비변화불대。
Objective To understand the pathogens distribution and characteristics of HFMD 2009—2012 in Shiji-azhuang. Methods Cases diagnosed as HFMD( part ordinary,all gathered,severe,and deaths) during 2009—2012 in Shi-jiazhuang were selected and their herpes,stool,throat swabs or rectal swabs were collected for pathogen detection. The spatial distribution analysis of monitoring data were made by combining with GIS. Results Within 4 years,3 842 biological specimens of HFMD in all were acquired,and the positive rate was 69. 29%(2 662),among which EV71 accounted for 50. 60%(1 347),CoxA16 accounted for 35. 05%(933) and others accounted for 14. 35%(382). Pathogenic components of HFMD dur-ing 2009 to 2012 were statistically significant(χ2 =2. 367,P <0. 001);CoxA16 predominated in 2009( accounting for 56. 46%),EV71 predominated in 2010 and 2011(accounting for 77. 34% and 57. 51%),in 2012 CoxA16 returned(account-ing for 66. 40%). The detected number of the positive pathogens was the highest in April or May and it decreased quickly in June. The CoxA16 presented the unimodal variable trend,but EV71 increased later with a " tail" phenomenon;other entero-viruses detected were relatively few without obvious time distribution character. There were regional differences of the distribution of pathogen in the same county area by the same year. The children under 1 year old were more susceptible to EV71. The propor-tion of severe cases of EV71 was significantly higher than that of ordinary cases,and almost all deaths were caused by EV71. Conclusion There are differences of HFMD etiology in Shijiazhuang. Dominant pathogens of CoxA16 and EV71 alternately pres-ent. EV71,CoxA16 and other intestinal virus respectively presents the multimodal,unimodal and non-significant time distri-bution characteristics. In the same epidemic year,the major pathogen in most counties are in agreement with that in the city as a whole,but there are exceptions in a couple of individual counties. As age increases,EV71 positive proportion reduces gradual-ly,CoxA16 positive ratio gradually increases and other intestinal virus proportion changes little.