2017—2018年西安市手足口病病原构成及肠道病毒71型分子特征分析  

Analysis of the pathogen profile of hand,foot and mouth disease and the molecular characteristics of enterovirus 71 in Xi′an from 2017 to 2018

作　　者：宋易纯 吴瑞[2] 薛泽润 陈海龙[2] 杜全丽[2] 韩月雯 杨玉捷 邓杨妮 马超锋[2] Song Yichun;Wu Rui;Xue Zerun;Chen Hailong;Du Quanli;Han Yuewen;Yang Yujie;Deng Yangni;Ma Chaofeng(Shaanxi University of Traditional Chinese Medicine,Xianyang,Shaanxi 712046;Xi′an Center for Disease Control and Prevention,Xi′an,Shaanxi 710054 China)

机构地区：[1]陕西中医药大学,咸阳712046 [2]西安市疾病预防控制中心,710054

出　　处：《中华实验和临床病毒学杂志》2021年第5期555-560,共6页Chinese Journal of Experimental and Clinical Virology

基　　金：西安市科技计划(20YXYJ0011-2,2019115713YX012SF050)。

摘　　要：目的了解2017—2018年西安市手足口病病原谱构成情况以及肠道病毒71型(enterovirus 71,EV-A71)VP1的基因特征。方法采集2017—2018年西安市手足口病哨点医院HFMD患者肛拭子标本1735例,采用实时荧光定量PCR鉴别EV-A71、柯萨奇病毒A组16型(coxsackievirus 16,CV-A16)和其他肠道病毒。分离培养部分EV-A71毒株,采用一步法逆转录-聚合酶链反应对VP1区进行基因扩增及测序,与本地区既往毒株进行同源性比对及遗传进化分析。结果共检测到肠道病毒核酸阳性样本1565例,阳性率为90.20%(1565/1735),其中EV-A71核酸阳性占24.79%(388/1565),CV-A16核酸阳性占21.85%(342/1565),其他肠道病毒核酸阳性则占53.36%(835/1565)。2017年与2018年的主要病原分别是EV-A71(45.08%)与其他肠道病毒(73.38%),病原构成差异有统计学意义(χ^(2)=370.57,P<0.001)。EV-A71所致手足口病集中在4~7月份,占总病例的73.97%(287/388)。EV-A71 VP1区同源性分析显示,分离到的20株EV-A71毒株均属于C4a亚型,核苷酸与氨基酸同源性分别为94.4%~96.1%、99.4%~100%,与以往西安市分离到的EV-A71同源性在91.5%以上。EV-A71 VP1区遗传进化分析结果显示,西安市2008—2018年EV-A71毒株与C4a亚型代表株处于同一分支,形成多个流行簇,且随着时间推移VP1区变异程度增大。结论其他肠道病毒为2017—2018年西安市手足口病主要病原,C4a亚型EV-A71仍在西安市持续流行,应加强对于HFMD病原谱及分子流行病学的监测,为进一步有效防治HFMD提供工作依据。Objective To understand the composition of the pathogen spectrum of hand,foot and mouth disease(HFMD)in Xi′an from 2017 to 2018 and the genetic characteristics of enterovirus 71(EV-A71).Methods From 2017 to 2018,1735 anal swab specimens from HFMD patients in Xi′an HFMD sentinel hospitals were collected,and qPCR was used to identify EV-A71,Coxsackie virus A 16(CV-A16)and other enteroviruses.Selected EV-A71 strains were isolated,and VP1 region was amplified and sequenced,then phylogenetic tree and homologic comparison were conducted.Results A total of 1565 positive samples of enterovirus RNA were detected,positive rate was 90.20%(1565/1735),of which 24.79%(388/1565)were positive for EV-A71,21.85%(342/1565)were positive for CV-A16,and 53.36%(835/1565)were positive for other enterovirus.The main pathogen in 2017 was EV-A71(45.08%)and in 2018 was non-EV-A71-non-CV-A16 enteroviruses(73.38%),and the difference in pathogen composition was statistically significant(χ^(2)=370.57,P<0.001).HFMD caused by EV-A71 was concentrated in April to July,accounting for 73.97%(287/388)of the total cases.The homology analysis of the EV-A71 VP1 region showed that the 20 isolated EV-A71 strains belonged to the C4a subtype,with nucleotide and amino acid homology of 94.4%-96.1%and 99.4%-100%respectively,which were separated from those of the previous Xi′an City,the homology of EV-A71 obtained was above 91.5%.The result of the genetic evolution analysis of the EV-A71 VP1 region showed that the EV-A71 strain and the representative strain of the C4a subtype in Xi′an from 2008 to 2018 were in the same branch,forming multiple epidemic clusters,the variation degree of VP1 region increased with time.Conclusions Non-EV-A71-non-CV-A16 enteroviruses were the main pathogens of HFMD in Xi′an from 2017 to 2018,and C4a subtype EV-A71 is still circulating in Xi′an.The monitoring of the pathogen spectrum and molecular epidemiology of HFMD should be strengthened to provide work for further effective prevention and treatment of HFMD.

关 键 词：手足口病 病原构成 肠道病毒71型 VP1基因 

分 类 号：R725.1[医药卫生—儿科] R440[医药卫生—临床医学]