CAJ | 학술논문

目的分析2013年北京地区手足口病住院患儿的病原学分布及主要病原所致手足口病的临床特点.方法收集2013年北京地坛医院的128例手足口病住院患儿的相关临床资料,采集粪便标本,采用One Step RT-PCR法进行肠道病毒分型检测,观察病原学分布特点,分析主要病原所致手足口病的临床特点,并扩增主要病原的VP1片段,构建进化树,简要分析其亲缘进化关系.结果共收集128例手足口病住院患儿,多见于≤2岁患儿(81.6％,102/125);共检出11种不同的肠道病毒,肠道病毒的总阳性率为76.6％ (98/128),柯萨奇病毒A组16型(CA6)阳性率为43.0％(55/128),肠道病毒71型(EV71)阳性率为14.8％(19/128).CA6手足口病患儿除在常见部位出现皮疹外,还易在非典型位置出现皮疹,如口周、躯干、四肢和面颈部(47％,26/55);55例CA6患儿中,6例出现了神经系统受累表现,其中1例伴有2型呼吸衰竭;EV71患儿较CA6患儿更易出现精神状态的改变[42％ (8/19)比11％ (6/55);x2=7.041,P=0.008].13例患儿在手足口病恢复期出现了指(趾)甲脱落[12例CA6(23％,12/53)和1例CA10患儿(17％,1/6)],与CA6感染之间存在明显相关性(x2=9.297,P=0.002).33例CA6 VP1亲缘进化树分析显示,本研究中的CA6与中国台湾的分离株高度相似,核苷酸相似性为95.91％～ 98.89％.结论 2013年北京地区手足口病住院患儿的主要病原为CA6,其次为EV71;CA6引起的手足口病皮疹累及范围广泛,可出现类似于EV71感染所见的神经系统受累甚至肺水肿;当神经系统受累时,EV71患儿易出现精神状态改变.
목적 분석2013년북경지구수족구병주원환인적병원학분포급주요병원소치수족구병적림상특점.방법 수집2013년북경지단의원적128례수족구병주원환인적상관림상자료,채집분편표본,채용One Step RT-PCR법진행장도병독분형검측,관찰병원학분포특점,분석주요병원소치수족구병적림상특점,병확증주요병원적VP1편단,구건진화수,간요분석기친연진화관계.결과 공수집128례수족구병주원환인,다견우≤2세환인(81.6％,102/125);공검출11충불동적장도병독,장도병독적총양성솔위76.6％ (98/128),가살기병독A조16형(CA6)양성솔위43.0％(55/128),장도병독71형(EV71)양성솔위14.8％(19/128).CA6수족구병환인제재상견부위출현피진외,환역재비전형위치출현피진,여구주、구간、사지화면경부(47％,26/55);55례CA6환인중,6례출현료신경계통수루표현,기중1례반유2형호흡쇠갈;EV71환인교CA6환인경역출현정신상태적개변[42％ (8/19)비11％ (6/55);x2=7.041,P=0.008].13례환인재수족구병회복기출현료지(지)갑탈락[12례CA6(23％,12/53)화1례CA10환인(17％,1/6)],여CA6감염지간존재명현상관성(x2=9.297,P=0.002).33례CA6 VP1친연진화수분석현시,본연구중적CA6여중국태만적분리주고도상사,핵감산상사성위95.91％～ 98.89％.결론 2013년북경지구수족구병주원환인적주요병원위CA6,기차위EV71;CA6인기적수족구병피진루급범위엄범,가출현유사우EV71감염소견적신경계통수루심지폐수종;당신경계통수루시,EV71환인역출현정신상태개변.
Objective To investigate the etiology of hand,foot and mouth disease (HFMD) in Beijing during 2013,and study the clinical characteristics of HFMD caused by the main serotypes of enterovirus in the study.Method Clinical data and 128 stool samples were collected from 128 hospitalized children with HFMD in Beijing Ditan Hospital during 2013.One step RT-PCR method was used for enterovirus genotyping to investigate the etiology of HFMD.Clinical characteristics of HFMD caused by the main serotypes of enterovirus were analyzed.And VP1 segments of the main virus were amplified to construct phylogenetic tree for the phylogenetic analysis.Result A total of 128 hospitalized children with HFMD were included.HFMD was more likely developed in children under 2 years of age (81.6％,102/125);11 different enteroviruses were genotyped,with a total enterovirus positive rate of 76.6％ (98/128);the positive rate of coxsackievirus A6 (CA6),43.0％ (55/128),was the highest,followed by enterovirus 71 (EV71),accounting for 14.8％ (19/128).HFMD caused by CA6 was atypical,the rashes of which involved the perioral,trunk,limbs,face and neck (47％,26/55),besides the common parts.Of the 55 cases caused by CA6,6 children had clinical manifestations of nervous system involvement,one of whom even displayed type 2 respiratory failure.Mental status change more likely to occur in EV71-infected children than in CA6-infected ones (42％ (8/19) vs.11％ (6/55) (x2 =7.041,P =0.008));13 children displayed onyehomadesis,including 12 CA6 cases (23％,12/53) and 1 CA10 cases (17％,1/ 6),in the convalescence of hand,foot and mouth disease,and the correlation between onychomadesis and CA6 infection was significant (x2 =9.297,P =0.002).Phylogenetic analysis of 33 CA6 VP1 showed that the CA6 isolates of this study were highly similar to that of Taiwan and the nucleotide similarity was 95.91％ -98.89％.Conclusion CA6 was the major pathogen of hospitalized children with hand,foot and mouth disease in Beijing during 2013,followed by EV71.The rashes caused by CA6 involved a wide range of skin sites and patients with CA6 infection displayed manifestations of neurological involvement or pulmonary edema similar to EV71 infection.Mental status change more likely occurred in EV7l-infected children when neurological system was involved.