2014年温州地区柯萨奇病毒A组6型手足口病的临床特征及分子流行病学特征分析  

Clinical characteristics and molecular epidemiology of coxsackievirus A6 hand, foot, and mouth disease in Wenzhou, 2014

作　　者：刘琦[1] 郑炜琨 夏蝉[1] 陈益平[1] 

机构地区：[1]温州医科大学附属第二医院儿童感染科,325027

出　　处：《中华传染病杂志》2016年第11期655-659,共5页Chinese Journal of Infectious Diseases

基　　金：温州市科技计划项目（Y20130353）

摘　　要：目的对柯萨奇病毒A组6型（CoxA6）手足口病进行临床特点及分子流行病学特征研究，以阐明此次疫情的特点。方法收集温州医科大学附属第二医院儿童感染科2014年7月至11月间临床确诊手足口病患者949例。所有患者均行肛拭子和（或）咽拭子检测，对病毒检测阳性的患者分为CoxA6组与非CoxA6组进行流行病学及临床特点分析，并于4周内进行门诊和（或）电话随访收集皮疹脱屑、指甲异常的情况。病毒检测CoxA6阳性者，通过反转录-PCR对CoxA6的VP1序列进行扩增、克隆和测序；通过Mega6．0软件对不同病毒株VP1序列进行系统发生分析。两组间计量资料比较采用t检验，计数资料比较采用x^2检验或Fisher精确概率法。结果最终实验室确诊560例，其中CoxA6446例（79．6％），人肠道病毒71型（EV71）44例（7．9％），CoxAl043例（7．7V00），CoxA1627例（4．8％）。CoxA6组体温〉39℃患儿比例显著高于非CoxA6组（71．3％比52．6％，x^2=14．42，P〈0．01），但持续时间短于非CoxA6组[（2．4±1．2）d比（3．1±1．4）d，t=-4．45，P〈0．01）；CoxA6组脑炎或脑膜炎神经系统受累方面显著低于CoxA6组，差异有统计学意义（O．7％比19．3％，x^2=81．53，P〈0．05）。CoxA6组口腔及口周皮疹（31．6％比13．2％，x^2=15．39）、小腿及前臂皮疹（32．3％比16．7％，x^2=10．74）、颈部及躯干皮疹（34．5％比8．8％，x^2=29．09）、皮疹溃疡及结痂（29．8％比18．4％，x^2=5．92），均显著高于非CoxA6组，且差异均有统计学意义（均P〈0．05）；而非CoxA6组皮疹主要局限于手掌及足底，与CoxA6组差异有统计学意义（93．9％比21．7％，x^2=1.94，P〈0．01）。CoxA6组疱疹（61．2％比28．9％，x^2=38．13）、大疱疹（23．3％比5．3％，x^2=18．75）比例均高于非CoxA6组（均P〈0．01）。出院4周内进行门诊和（或）电话随访，CoxA6Objective To investigate the clinical characteristics and molecular epidemiology of coxsackievirus （Cox）A6 hand, foot, and mouth disease （HFMD）, and to illustrate the features of the epidemic situation. Methods Totally 949 patients diagnosed with HFMD at Department of Pediatric Infection in the Second Hospital -Affiliated to Wenzhou Medical University from July to November in 2014 were collected. The anal and/or throat swabs were collected from all the patients. Patients with positive results of enterovirus test were classified into two groups including CoxA6 group and nowCoxA6 group, and were followed up for rash, desquamation and nail abnormalities at clinic or by phone within 4 weeks post HFMD infection. The viral protein （VP） 1 region was amplified, cloned and sequenced by using the reverse transcription polymerase chain reaction （PCR） in patients with positive CoxA6 results. Phylogenetic tree was constructed by VP1 gene sequences of different CoxA6 strains using MEGA 6.0 software. The continuous variables between two independent groups were compared by t-test. The categorical variables were compared by Chi square test or Fisher test. Results A total of 560 patients confirmed by lab diagnosis tests were recruited, including 446 cases （79.6 %） in CoxA6 group and 114 cases （20.3 %） in non-CoxA6 group. The percentage of patients with body temperature 〉39 ℃ in CoxA6 group was significantly higher than non-CoxA6 group （71.3 % vs 52.6 %, x^2= 14.42, P〈0.01）. However, the duration of fever in CoxA6 group was shorter than non-CoxA6 group （[2.4±1.2] d vs [-3. 1±1.41 d, t=-4.45, P〈0.01）. The incidence of encephalitis/meningitis and neurological complications in CoxA6 group were significantly lower than non-CoxA6 group （0.7% vs 19.3%, x^2= 81.53, P〈0.05）. The distributions of rashes involving oral and perioral area （31.6% vs 13.2%, x^2= 15.39）, limbs and forearm （32.3% vs 16.7%, x^2= 10.74）, neck and struck （34.5% vs 8.8%, x^2= 29.09）, skin ulcer and scabs （

关 键 词：柯萨奇病毒A6 手足口病 脱皮 脱甲 VP1序列 

分 类 号：R725.1[医药卫生—儿科]