2014年济南市一起聚集性病毒性脑炎的调查及快速病原学鉴定  

Epidemiological survey and rapid etiological identification of an clustered viral encephalitis in Jinan,2014

作　　者：关恒云[1] 王春荣[1] 刘岚铮[1] 杨国樑[1] 赵小东[2] 吕燕[1] 韩秀云[1] 张先慧[2] 徐胜平[2] 

机构地区：[1]济南市疾病预防控制中心病毒性疾病检验所,250021 [2]济南市疾病预防控制中心传染病防治所,250021

出　　处：《中华实用儿科临床杂志》2015年第10期769-771,共3页Chinese Journal of Applied Clinical Pediatrics

基　　金：山东省医药卫生科技发展计划项目（2011HW009）

摘　　要：目的 快速鉴定2014年济南市一起聚集性病毒性脑炎的病原体,分析其流行病学及病原学特征.方法 采用统一的个案调查表对住院患儿逐一进行个案调查.4例患儿均采集粪便和脑脊液标本.采用实时荧光定量（RT） PCR方法检测总肠道病毒（PE）、肠道病毒71型（EV71）、柯萨奇病毒A组（CVA） 16、10和6型病毒核酸;PE阳性标本采用巢式反转录PCR方法扩增5＆#39;-UTR区基因,测定核苷酸序列并进行同源性分析.结果 本起聚集性病毒性脑炎疫情首发病例出现于2014年4月8日,呈人传人的传播模式.RT-PCR结果显示,所有标本PE核酸检测为阳性,而EV71、CVA16、CVA10和CVA6核酸检测均为阴性.5＆#39;-UTR区核苷酸序列在美国生物技术信息中心网站经碱基局部对准检索工具分析（http：//blast.ncbi.nlm.nih.gov/Blast.cgi）显示与肠道病毒柯萨奇病毒B5（CVB5）同源性最高,彼此之间核苷酸同源性为99.2％ ～ 100.0％,与2010年河南株CVB5（HQ998851）的核苷酸同源性为96.7％～97.4％.4例患儿经积极的抗病毒、抗感染及相关对症支持治疗,均痊愈出院,无后遗症发生.结论 本起聚集性病毒性脑炎病原体为CVB5,与2010年河南株CVB5核苷酸同源性最高.RT-PCR和巢式反转录PCR方法可快速、准确地鉴定肠道病毒引起的病毒性脑炎.Obgective To rapidly identify the pathogen of a clustered viral encephalitis in Jinan,2014,and to analyze the epidemiological and etiological characteristics.Methods Uniform questionnaire was used to investigate each case.Both stool and cerebrospinal fluid specimens of 4 children were collected.At first,real-time fluorescence quantitative（RT） PCR was performed to detect the viral nucleic acid of pan-enterovirus （PE）,enterovirus 71 （EV71）,coxsackievirus A16 （CVA1 6）,coxsackievirus A10 （CVA10） and coxsackievirus A6 （CVA6）.Then nested reverse transcription-PCR based on 5＆#39;-UTR gene of enterovirus was conducted for the PE positive specimens.The PCR products were sequenced and homologous analysis were performed.Results The initial case appeared on the April 8,2014 in the from of clustered viral encephalitis and the transmission mode was person-to-person.The RT-PCR resuits showed that PE was positive for all the specimens,while others including EV71,CVA16,CVA10 and CVA6 were negative.Analysis based on 5＆#39;-UTR through Basic Local Alignment Search Tool （http：//blast.ncbi.nim.nih.gov/ Blast.cgi） sequences indicated that coxsackievirus B5 （CVB5） was the main pathogen and 99.2%-130.0% homology from each other.Data from homologous comparisons showed that these sequences had homology of 96.7%-97.4%with Henan CVB5 strain（HQ998851）.These 4 children all recovered after the treatment with antiviral medications,anti-infective agents,and supportive therapy.Conclusions CVB5 was responsible for the clustered viral encephalitis in Jinan,2014 and it had high homology with Henan CVB5 strain.RT-PCR and nested reverse transcription-PCR are rapid and effective methods to identify viral encephalitis caused by enterovirus.

关 键 词：病毒性脑炎 柯萨奇病毒B5 实时荧光定量聚合酶链反应 巢式反转录聚合酶链反应 

分 类 号：R725.1[医药卫生—儿科]