2016年天津手足口病住院患儿的病原构成与分子分型  

The pathogenic composition and molecular typing of hospitalized children with hand, foot and mouth disease in Tianjin in 2016

作　　者：潘蕊[1] 林书祥[2] 舒剑波[2] 孟英韬[2] 邹映雪[3] 彭林[4] Pan Rui Lin Shuxiang Shu Jianbo Meng Yingtao Zou Yingxue Peng Lin(Grade 2015, Laboratory Medicine, Graduate School of Tianfin Medical University, Tianjin 300070, China)

机构地区：[1]天津医科大学研究生院临床检验诊断2015级,300070 [2]天津市儿童医院天津市儿科研究所 [3]天津市儿童医院感染科 [4]天津市儿童医院

出　　处：《中华检验医学杂志》2017年第5期367-371,共5页Chinese Journal of Laboratory Medicine

基　　金：天津市卫生局基金（2014KZ033）

摘　　要：目的分析2016年天津市儿童医院住院患儿手足口病的病原构成,并对引起手足口病流行的肠道病毒进行分子分型.方法单中心研究.采集2016年3至11月在天津市儿童医院住院患儿的手足口病临床病例标本327份,采用实时荧光逆转录聚合酶链反应（RT-PCR）检测肠道病毒（EV）、肠道病毒71型（EV71）及柯萨奇病毒A16（CA16）,采用RT-PCR法对104份其他肠道病毒阳性标本进行衣壳蛋白VP1（VP1）区基因扩增和序列检测,运用生物软件Chromas1.62及MEGA6.06进行测序结果分析并构建系统进化树.用SPSS20.0软件对不同年龄组患者EV阳性检出率进行比较分析.结果327份标本中检出肠道病毒（EV）阳性272份,肠道病毒71型（EV71）、柯萨奇病毒A16型（CA16）及非EV71非CA16其他肠道病毒（其他EV）分别占55.1％（150/272）,6.6％（18/272）和38.2％（104/272）;不同年龄组患者肠道病毒阳性检出率69.0％-90.9％,各年龄组差异有统计学意义（χ^2=15.897,P=0.044）,3岁组阳性检出率最高（90.9％,40/44）.104份其他EV阳标本中检出CA10阳性34份,占12.5％,CA6阳性14份,占5.1％.11株EV71和20株CA10VP1亲缘进化树分析分别显示,11株EV71型序列均为C4基因亚型的C4a分支,20株CA10均为G型.结论2016年天津手足口病的病原中其他EV构成比明显上升,但EV71仍为本年的优势病原.加强对手足口病的病原学监测对手足口病的防控工作至关重要.Objective To explore pathogenic composition of hand,foot and mouth disease（HFMD）,and the molecular typing of enterovirus in Tianjin Children′s Hospital in 2016.Methods Single center study.A total of 327 samples of HFMD cases which collected from Tianjin Children′s Hospital from March to November in 2016 were tested for nucleotide acid of enterovirus（EV）,human enterovirus 71（EV71）,Coxsackievirus A 16（CA16）by real-time reverse transcription polymerase chain reaction（RT-PCR）,among which 104 sample of other EV positive were selected to amplify and sequence the whole VP1 region by using RT-PCR.Homology was analyzed and phylogenetic tree were constructed by comparison of the sequence with all subgenotype of EV by Chromas1.62 and MEGA6.06.EV positive rate in different age groups were compared by SPSS20.0.Results Of all the 327 HFMD cases tested,there were 272 EV positive cases,the constituent ratio of EV71,CA16 and other EV were 55.1%（150/272）,6.6%（18/272）and 38.2%（104/272）respectively.The EV positive rates of different age groups（69.0%-90.9%）were different significantly（χ^2=15.897,P=0.044）,the 3 years-old-group had the highest EV positive rate than that of the other age groups（90.9%,40/44）.Of all 104 samples of other EV tested,34 were CA10（12.5%）and 14 were CA6（5.1%）.Phylogenetic analysis of 11 EV71 VP1 and 20 CA10 VP1 showed that the EV71 and CA10 strains belonged to genotype C4a and genotype G,respectively.ConclusionsEV71 was still the predominant pathogen in spite of the constituent ratio of other EVs increased markedly in 2016 in Tianjin.It is important to enhance etiological monitoring for control and prevention of HFMD.

关 键 词：手足口病 肠道病毒属 基因型 逆转录聚合酶链反应 儿童 住院 

分 类 号：R725.1[医药卫生—儿科]