CAJ | 학술논문

目的观察手足口病患儿大便中肠道病毒71型(EV71)、柯萨奇病毒A组16型(CoxA16)的持续存在时间；探讨手足口病患儿肠道排毒时间与病情严重程度的关系.方法对113例EV71、CoxA16感染的手足口病患儿进行随访,每隔4～7d收集1次大便标本,用荧光聚合酶链式反应(PCR)法进行病毒核酸检测,直至大便病毒核酸转阴为止.并用Kaplan-Meier生存分析法进行分析.结果 113例患儿中,EV71阳性者65例,CoxA16阳性者44例,混合感染者4例.EV71组患儿在第1、4、6、10周的大便病毒核酸阳性率分别为100％、48.1％、17.2％、0;CoxA16组患儿在第1、4、6周的大便病毒核酸阳性率分别为95.5％、53.8％、0.两组大便病毒核酸阳性率的分布差异无统计学意义(x2=0.18,P＞0.05).EV71普通型组患儿在第1、4、6周的大便病毒核酸阳性率分别为100％、23.5％、0;EV71重症组患儿在第1、4、6、10周的大便病毒核酸阳性率分别为100％、62.4％、26.0％、0.EV71普通型组和重症组大便病毒核酸阳性率的分布差异有统计学意义(x2=5.689,P＜0.05).结论手足口病患儿大便中病毒可存在较长的时间:EV71持续最长时问为10周；CoxA16持续最长时间为6周.感染EV71的手足口病患儿的肠道排毒持续时间与病情轻重相关.
목적 관찰수족구병환인대편중장도병독71형(EV71)、가살기병독A조16형(CoxA16)적지속존재시간；탐토수족구병환인장도배독시간여병정엄중정도적관계.방법 대113례EV71、CoxA16감염적수족구병환인진행수방,매격4～7d수집1차대편표본,용형광취합매련식반응(PCR)법진행병독핵산검측,직지대편병독핵산전음위지.병용Kaplan-Meier생존분석법진행분석.결과 113례환인중,EV71양성자65례,CoxA16양성자44례,혼합감염자4례.EV71조환인재제1、4、6、10주적대편병독핵산양성솔분별위100％、48.1％、17.2％、0;CoxA16조환인재제1、4、6주적대편병독핵산양성솔분별위95.5％、53.8％、0.량조대편병독핵산양성솔적분포차이무통계학의의(x2=0.18,P＞0.05).EV71보통형조환인재제1、4、6주적대편병독핵산양성솔분별위100％、23.5％、0;EV71중증조환인재제1、4、6、10주적대편병독핵산양성솔분별위100％、62.4％、26.0％、0.EV71보통형조화중증조대편병독핵산양성솔적분포차이유통계학의의(x2=5.689,P＜0.05).결론 수족구병환인대편중병독가존재교장적시간:EV71지속최장시문위10주；CoxA16지속최장시간위6주.감염EV71적수족구병환인적장도배독지속시간여병정경중상관.
Objective To observe the duration of enterovirus-71 (EV71) and coxsackievirus A 16 (CoxA16) viral shedding in stool samples of children with hand,foot and mouth disease (HFMD) infected with EV71 and CoxA16 and to explore the relationship between the duration of intestinal virus shedding and the severity of illness of children with HFMD.Method Totally 113 laboratory-confirmed cases of children with HFMD infected with EV71 and CoxA16 were followed up.The stool samples were collected with the interval of 4 to7 days and the viral nucleic acids were detected by fluorescent PCR until the stool viral nucleic acids of infected children turned to be negative.The cases in EV71 group were further divided into "ordinal EV71 group" and " severe EV71 group" according to the severity of the illness.The positive rates of viral uucleic acid and the differences of distribution among different groups were analyzed by Kaplan-Meier survival analysis during the follow-up period.Result The 113 cases of infected children were grouped as follows:65 cases of EV71 positive children,44 cases of CoxA16 positive children,4 cascs of EV71/CoxA16 mixed infection.The median duration of the stool viral nucleic acids turning to negative was 26 (18.25-32.50)days in EV71 group and 27(14.50-33.75) days in CoxA16 group (Z =1.51,P ＞0.05).At 1,4,6 and 10 weeks,the positive rates of stool viral nucleic acid of children with HFMD in EV71 group were 100％,48.1％,17.2％ and 0 respectively.At 1,4 and 6 weeks,the positive rates of stool viral nucleic acid of children with HFMD in CoxA16 group were 95.5％,53.8％ and 0 respectively (x2 =0.18,P ＞0.05).At 1,4 and 6 weeks,the positive rates of stool viral nucleic acid of children with HFMD in ordinary EV71 group were 100％,23.5％ and 0 respectively,while at 1,4,6 and 10 weeks,the positive rates of stool viral nucleic acid of children with HFMD in severe EV71 group were 100％,62.4％,26.0％ and 0 respectively (x2 =5.689,P ＜ 0.05).Conclusion The duration of enterovirus shedding in stool samples of children with HFMD lasted for a long period.The maximum duration of EV71 and CoxAl6 in stool of children with HFMD was 10 weeks and 6 weeks,respectively.The duration of intestinal virus shedding of children with HFMD infected with EV71 was related with the severity of the illness.