潮汕地区2011至2015年重症手足口病病原学变化趋势分析  

Change trends of pathogen of severe hand, foot and mouth disease in Chaoshan area during 2011 to 2015

作　　者：蔡晓莹[1] 杨林芝 林广裕[1] 林创兴[1] 陈派镇[1] 吴家敏[1] 陈洁玲[1] 陆学东[2] 

机构地区：[1]汕头大学医学院第二附属医院儿科,515041 [2]中山大学附属第八医院检验科,深圳518000

出　　处：《中国小儿急救医学》2018年第1期27-31,共5页Chinese Pediatric Emergency Medicine

基　　金：广东省高水平大学重点学科建设项目（2050205）

摘　　要：目的 探讨潮汕地区2011至2015年重症手足口病病原学变化趋势.方法 收集2011年5月至2015年8月临床诊断为手足口病收住在我院儿科的患儿咽拭子标本1410份,应用巢式RT-PCR技术检测肠道病毒,对最后确诊为重症手足口病并且肠道病毒检测阳性病例进行分析.结果（1）临床诊断重症手足口病且检测肠道病毒阳性216例（67.29％,216/321）,其中肠道病毒71型（enteroviruses 71,EV71）阳性116例（116/216,53.70％）,柯萨奇A组（coxsackievirus A,CA）16型（CA16）阳性43例（43/216,19.91％）,CA6阳性26例（26/216,12.04％）,CA10阳性19例（19/216,8.80％）,CA4阳性7例（7/216,3.24％）,柯萨奇B组5型阳性2例（2/216,0.93％）,埃可病毒6型阳性1例（1/216,0.46％）,未分型2例（2/216,0.93％）.（2）5例危重症手足口病病例均为EV71阳性.（3）EV71阳性患儿以重症病例为主（51.79％,116/224）,非EV71阳性病例以非重症病例为主（82.08％,458/558）,差异有统计学意义（χ2=91.68,P〈0.001）.（4）重症手足口病比例逐年改变的趋势与EV71构成比改变趋势一致,且两者高度相关（相关系数Rs=0.9,P=0.037）.（5）非EV71肠道病毒感染所致的重症手足口病比例逐渐上升.结论 2011至2015年潮汕地区重症手足口病病原总构成以EV71为主,其他类型的肠道病毒如CA16、CA6、CA10、CA4、柯萨奇B组5型、埃可病毒6型也能引起重症手足口病;在以EV71为优势病原的年份,重症手足口病构成比也相应增加. 2013年以后,非EV71肠道病毒感染所致的重症手足口病比例有逐渐上升趋势.Objective To discuss the change trends of pathogen of severe hand,foot and mouth dis-ease（HFMD） in Chaoshan area during 2011 to 2015. Methods All 1410 throat swabs of cases who were diagnosed as HFMD were collected from children hospitalized in our hospital during May 2011 to August 2015. Enterovirus were detected by nest RT-PCR,and the results of these positive cases diagnosed as severe HFMD were analyzed. Results （1） There were 216 positive cases（67. 29%,216/321） diagnosed as severe HFMD,including 53. 70% （ 116/216 ） enterovirus 71 （ EV71 ）, 19. 91% （ 43/216 ） coxsackievirus A16 （CA16）,12. 04%（26/216） CA6,8. 80%（19/216） CA10,3. 24%（7/216） CA4,0. 93%（2/216） coxsack-ievirus B5, 0. 46% （ 1/216 ） enteric cytopathogenic human orphan virus and 0. 93% （ 2/216 ） unclassified samples were unclassified to species. （2） Five cases of critical HFMD were all caused by EV71. （3） The EV71 positive samples were given priority to severe cases （ 51. 79%,116/224 ） and the non EV71 positive samples were given priority to mild cases （ 82. 08%, 458/558 ） , the difference was statistically significant （χ2 =91. 68,P〈0. 001）. （4） The change trends of severe HFMD year by year were consistent with the change trends of EV71 composition,and were highly correlated（Rs=0. 9,P=0. 037）. （5） Severe HFMD caused by non EV71 virus gradually increased. Conclusion Severe HFMD in Chaoshan area during 2011 to 2015 were mainly caused by EV71,non EV71 viruses including CA16,CA6,CA10,CA4,coxsackievirus B5, enteric cytopathogenic human orphan virus 6 could also develop to severe HFMD. The composition ratio of severe HFMD increased accordingly in the year of EV71 as the dominant pathogen. The proportion of severe HFMD caused by non EV71 virus gradually increased after 2013 year.

关 键 词：重症手足口病 病原 肠道病毒71型 非EV71型肠道病毒 

分 类 号：R725.1[医药卫生—儿科]