2013至2014年北京手足口病流行季相关肠道病毒型别变化和分析
2013지2014년북경수족구병류행계상관장도병독형별변화화분석
Analysis on the change of genotype of enteroviruses associated hand, foot and mouth disease in Beijing during 2013 to 2014
  • 万方数据
    中华儿科杂志 중화인과잡지
    Chinese Journal of Pediatrics
    2015年 8期 610-615 ,共6页

    宋秦伟%黄辉%邓洁%赵林清%邓莉%孙宇%王芳%钱渊%朱汝南

    송진위%황휘%산길%조림청%산리%손우%왕방%전연%주여남

    手足口病%肠道病毒属%基因型%儿童 手足口病%腸道病毒屬%基因型%兒童
    수족구병%장도병독속%기인형%인동
    Hand,foot and mouth disease%Enterovirus%Genotype%Child
    目的 分析北京2013至2014年手足口病流行期间肠道病毒的型别、流行趋势和临床特点,为手足口病的防治提供科学依据.方法 2013年4至9月和2014年3至10月,首都儿科研究所附属儿童医院感染门诊就诊患儿的咽拭子标本共977份,其中2013年初步诊断手足口病患儿标本147份;2014年初步诊断手足口病患儿标本343例,不典型手足口病患儿标本201份,疱疹性咽峡炎患儿标本83份,发热伴抽搐患儿标本25份,发热伴出疹患儿标本64份,皮疹待查患儿标本114份.采用实时荧光逆转录聚合酶链反应方法检测肠道病毒(EV)通用型,肠道病毒71型(EV71)和柯萨奇病毒A组16型(CA16);采用巢式PCR方法对EV通用型阳性而非EV71和CA16的标本核酸进行VP1片段的扩增和测序分析以鉴定型别.分别比较不同年龄组、不同年份间肠道病毒的检出情况,分析其在两个年份的流行趋势.结果 977份标本总阳性率为80.1％(783/977),其中CA16为25.6％(250/977),EV71为18.9％(185/977),CA6为20.0％(195/977),CA10为5.0％ (49/977),CA4为1.5％ (15/977),其他EV为9.1％(89/977),阴性19.9％(194/977).2013年和2014年检出的各型别地方株同型间均具有较高的同源性,CA6的同源性为94.3％ ～ 100％,CA10的同源性为93.8％ ～99.1％,CA4的同源性为92.7％ ～99.8％.≤1岁年龄患儿肠道病毒总阳性率为71.1％(106/149),低于其他年龄组(P均＜0.05),但与＞5岁组相近(x2 =1.181,P=0.277).2013年147例手足口病患儿标本中肠道病毒阳性率为85.7％ (126/147),CA6为优势型别占54.8％(69/126),其次是CA16和EV71,分别为20.6％(26/126)和11.9％(15/126).2014年343例手足口病患儿标本中肠道病毒阳性率为85.4％(293/343),CA16和EV71成为主要型别,分别占42.7％(125/293)和38.2％(112/293),而CA6仅占11.3％(33/293).2014年不典型手足口病、疱疹性咽峡炎、发热伴抽搐、发热伴出疹和皮疹待查患儿标本的肠道病毒阳性率分别为83.6％(168/201),80.7％(67/83),76.0％(19/25),64.1％ (41/64)和60.5％(69/114).各型肠道病毒的流行高峰主要集中在5至8月份,而每年各型肠道病毒的流行趋势却没有明显的规律.结论 北京地区引发儿童手足口病的肠道病毒,2013年CA6占据第一,2014年CA16和EV71再次成为主要型别;CA6、CA10和CA4等型别肠道病毒引发的临床症状与EV71和CA16引发的临床症状可能存在差异;除EV71和CA16外,也需要重视对CA6、CA10和CA4等其他型别肠道病毒的监测和研究.
    목적 분석북경2013지2014년수족구병류행기간장도병독적형별、류행추세화림상특점,위수족구병적방치제공과학의거.방법 2013년4지9월화2014년3지10월,수도인과연구소부속인동의원감염문진취진환인적인식자표본공977빈,기중2013년초보진단수족구병환인표본147빈;2014년초보진단수족구병환인표본343례,불전형수족구병환인표본201빈,포진성인협염환인표본83빈,발열반추휵환인표본25빈,발열반출진환인표본64빈,피진대사환인표본114빈.채용실시형광역전록취합매련반응방법검측장도병독(EV)통용형,장도병독71형(EV71)화가살기병독A조16형(CA16);채용소식PCR방법대EV통용형양성이비EV71화CA16적표본핵산진행VP1편단적확증화측서분석이감정형별.분별비교불동년령조、불동년빈간장도병독적검출정황,분석기재량개년빈적류행추세.결과 977빈표본총양성솔위80.1％(783/977),기중CA16위25.6％(250/977),EV71위18.9％(185/977),CA6위20.0％(195/977),CA10위5.0％ (49/977),CA4위1.5％ (15/977),기타EV위9.1％(89/977),음성19.9％(194/977).2013년화2014년검출적각형별지방주동형간균구유교고적동원성,CA6적동원성위94.3％ ～ 100％,CA10적동원성위93.8％ ～99.1％,CA4적동원성위92.7％ ～99.8％.≤1세년령환인장도병독총양성솔위71.1％(106/149),저우기타년령조(P균＜0.05),단여＞5세조상근(x2 =1.181,P=0.277).2013년147례수족구병환인표본중장도병독양성솔위85.7％ (126/147),CA6위우세형별점54.8％(69/126),기차시CA16화EV71,분별위20.6％(26/126)화11.9％(15/126).2014년343례수족구병환인표본중장도병독양성솔위85.4％(293/343),CA16화EV71성위주요형별,분별점42.7％(125/293)화38.2％(112/293),이CA6부점11.3％(33/293).2014년불전형수족구병、포진성인협염、발열반추휵、발열반출진화피진대사환인표본적장도병독양성솔분별위83.6％(168/201),80.7％(67/83),76.0％(19/25),64.1％ (41/64)화60.5％(69/114).각형장도병독적류행고봉주요집중재5지8월빈,이매년각형장도병독적류행추세각몰유명현적규률.결론 북경지구인발인동수족구병적장도병독,2013년CA6점거제일,2014년CA16화EV71재차성위주요형별;CA6、CA10화CA4등형별장도병독인발적림상증상여EV71화CA16인발적림상증상가능존재차이;제EV71화CA16외,야수요중시대CA6、CA10화CA4등기타형별장도병독적감측화연구.
    Objective To analyze the genotype,epidemic pattern and the characteristics of the disease of enteroviruses during the epidemic season of hand,foot and mouth disease (HMFD) in children from 2013 to 2014 in Beijing to provide the scientific evidence for prevention and treatment of HFMD.Method During April to September in 2013 and March to October in 2014,a total of 977 throat swabs were collected from children who visited the Children's Hospital Affiliated to Capital Institute of Pediatrics,including 147 from patients with HFMD in 2013,343 with HFMD,201 with atypical HFMD,83 with herpangina,25 with fever with convulsions,64 fever with rash and 114 with rash in 2014.Enteroviruses universal type (EV),Enteroviruses type 71 (EV71) and Coxsackievirus group A 16 (CA16) were detected by real-time RT-PCR respectively.The nucleic acid of specimens which were identified with non-EV71,non-CA16 was tested by nested PCR and analyzed by VP1 sequencing.The detection rate and epidemic pattern of different genotypes of enterovirus were analyzed among different age groups and between 2013 and 2014.Result Of 977 throat swabs,80.1％ samples were detected positive for enteroviruses.The positive rates of CA16,EV71,CA6,CA10,CA4 and other EVs were 25.6％ (250/977),18.9％ (185/977),20.0％ (195/977),5.0％ (49/977),1.5％ (15/977)and 9.1％ (89/977),respectively.Twenty six of the 89 other EVs included CA2,CA5,CA8,CA9,CA12,CA14,CB2,CB5,E6,E9 and E25,each genotype of which was no more than 3.The nucleotide homologies shared among CA6,CA10 and CA4 strains between 2013 and 2014 were 94.3％-100％,93.8％-99.1％ and 92.7％-99.8％,respectively.The positive rates of ≤ 1 year group were 71.1％ (106/149),which was lower than that of other age groups (all P ＜0.05),but similar to that of ＞5 year group (x2 =1.181,P =0.277).In 2013,the positive rate of EV was 85.7％ (126/147) and the predominant genotype was CA6 54.8％ (69/126),followed by CA16 20.6％ (26/126) and EV71 11.9％ (15/126).In 2014,the positive rate of EV was 85.4％ (293/343) in the 343 children with HFMD,the predominant genotypes were CA16 with the positive rate of 42.7％ (125/293),EV71 with 38.2％ (112/293) and CA6 with only 11.3％ (33/293).In 2014,the positive rates of EV in 201 atypical HFMD,83 herpangina,25 fever with convulsions,64 fever with rash and 114 rash were 83.6％ (168/201),80.7％ (67/83),76.0％ (19/25),64.1％ (41/64) and 60.5％ (69/114),respectively.All genotypes of enteroviruses peaked mainly during May to August every year,but there were no obvious epidemiological pattern about each genotype.Conclusion CA6 became the main causative agent of HFMD in 2013,however,CA16 and EV71 predominated again in 2014 in Beijing.The clinical manifestations caused by CA6,CA10,CA4 and other genotype of enteroviruses differed from EV71 and CA16.Besides EV71 and CA16,more attention should be paid to CA6,CA10,CA4 and other type of enteroviruses.
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