吉林省长春市手足口病患者流行病学特征及肠道病毒71型VP1基因特征分析  

Epidemiological characteristics of patients with hand-foot-mouth disease in Changchun City of Jilin Province and genetic characteristics of enterovirus 71 VP1

作　　者：张兴国[1] 李晨光 张智丽 孙宇[1] 崔薇[1] 初秋[1] 乔凤娟[1] 王宇冰 孙炳欣[1] ZHANG Xingguo;LI Chenguang;ZHANG Zhili;SUN Yu;CUI Wei;CHU Qiu;QIAO Fengjuan;WANG Yubing;SUN Bingxin(Institute of Microbiology,Changchun Disease Control and Prevention Center,Jilin Province,Changchun 130033,China)

机构地区：[1]吉林省长春市疾病预防控制中心微生物检验所,吉林长春130033

出　　处：《吉林大学学报（医学版）》2022年第1期234-240,共7页Journal of Jilin University：Medicine Edition

基　　金：吉林省卫健委卫生与健康技术创新项目(2018J008)。

摘　　要：目的:分析2014-2018年吉林省长春市手足口病流行特征及肠道病毒71型(EV-A71)VP1基因特征,探讨其流行规律,为及时调整防控策略提供参考依据。方法:利用中国疾病预防控制信息系统中的数据,采用描述性流行病学方法对2014-2018年吉林省长春市手足口病疫情数据进行分析。收集2014-2018年吉林省长春市医疗机构报告手足口病临床诊断病例咽拭子标本,采用实时荧光定量PCR(RT-qPCR)法检测标本中总肠道病毒、肠道病毒71型(EV-A71)和柯萨奇病毒A组16型(Cox-A16),确定型别。对EV-A71的VP1区扩增并测序,比对构建系统进化树,分析同源性和氨基酸变异位点。结果:2014-2018年吉林省长春市累计报告手足口病病例12685例,发病率呈现先降后升趋势,2016年达到高峰,之后呈逐年递降趋势。每年流行趋势基本相同,呈单峰分布,有明显的季节性。吉林省长春市14个县区均有病例报告,年均报告发病率前3位的地区为高新区(129.14/10万)、宽城区(102.17/10万)和经开区(100.98/10万)。病例中,男性比例明显高于女性,以5岁以下儿童为主。吉林省长春市EV-A71阳性样本各月份均有检出。2014年3-9月和2017年5月-2018年5月,手足口病毒型别以EV-A71为主,且呈逐渐上升趋势。测序获得EV-A71序列146条,其中除2017年3条序列和2018年7条序列属于EV-A71的B5亚型外,其余序列均属于C4亚型中的C4a亚型。VP1区145氨基酸位点为E,2018年2株检测到VP1104D,另外3株检测到VP1218R,其余各株主要毒理位点和抗原性位点未发生变异,EV-A71的B5亚型较C4亚型有VP143E、VP158T和VP1184T3个氨基酸位点差异。结论:吉林省长春市手足口病发病主要发生在5岁以下男性幼童,引发手足口病流行的肠道病毒以EV-A71为主,主要为C4a亚型,也有少部分B5亚型的流行,部分氨基酸变异位点需持续监测,以免造成大范围流行。Objective:To investigate the epidemiological characteristics of hand-foot-mouth disease(HFMD)and the genetic characteristics of VP1 coding gene of enterovirus A71(EV-A71)in Changchun City of Jilin Province during 2014-2018,and to explore its epidemic law and provide reference to adjust measures of disease control and prevention promptly.Methods:Using data from China disease Control and Prevention Information System,the epidemiological data of the hand-foot-mouth disease were analyzed with descriptive epidemiological method.The throat swab speimens of the patients with hand-foot-mouth disease were collected from Changchun medical institutions from 2014 to 2018.Real-time fluorescence quantitative PCR(RT-PCR)was used to detect the total enterovirus,enterovirus 71(EV-A71)and Coxsackieevirus 16(CV-A16)in the speimens to confirm the types.The VP1 regions of EV-A71 were amplificated and sequenced and the phylogenetic tree was constructed.The homology sites and amino acid variation sites were analyzed.Results:From 2014 to 2018,a total of 12685 cases were reported in Changchun City of Jilin Province with the incidence decreasing first and then increasing,reaching a peak in 2016 and decreasing year by year thereafter.The epidemic trend was basically the same,showing a single peak distribution,with obvious seasonal.The cases were reported in 14 counties and districts of Changchun City,and the top three areas with annual incidence were high-tech zone(129.14/100000),broad urban area(102.17/100000)and economic development zone(100.98/100000).The proportion of male cases was significantly higher than that of female cases,and the majority of cases were children under 5 years old.The EV-A71 positive samples were detected every month in Changchun City.During the study period from March to September 2014 and from May 2017 to May 2018,EV-A71 was the main causative agent of hand-foot-mouth disease,showing a gradually upward trend.A total of 146 EV-A71 sequences were obtained,136 of the EV-A71 strains samples belonged to C4a subtypes

关 键 词：手足口病 肠道病毒71型 VP1蛋白 基因型别 流行病学 

分 类 号：R115[医药卫生—公共卫生与预防医学] R373.2