2019—2021年西安市手足口病的病原学特征分析  

Etiological characteristics of hand, foot and mouth disease in Xi′an from 2019 to 2021

作　　者：薛泽润 吴瑞[1] 陈海龙[1] 杜全丽[1] 韩月雯 杨玉捷 邓杨妮 马超锋[1] Xue Zerun;Wu Rui;Chen Hailong;Du Quanli;Han Yuewen;Yang Yujie;Deng Yangni;Ma Chaofeng(Viral Diseases Laboratory,Xi′an Municipal Center for Disease Control and Prevention,Xi′an 710054,China)

机构地区：[1]西安市疾病预防控制中心病毒科,西安710054

出　　处：《中华微生物学和免疫学杂志》2023年第5期381-388,共8页Chinese Journal of Microbiology and Immunology

基　　金：西安市科技计划项目(22YXYJ0047)。

摘　　要：目的分析2019—2021年西安市手足口病(hand, foot and mouth disease, HFMD)的病原构成及其流行病学特征, 为防控HFMD提供科学依据。方法收集临床诊断为HFMD的肛拭子或粪便标本, RT-PCR法检测肠道病毒(enterovirus, EV), 鉴别出肠道病毒71型(enterovirus 71, EV71)、柯萨奇病毒A组16型(coxsackievirus A16, CVA16)、柯萨奇病毒A组6型(CVA6)、柯萨奇病毒A组10型(CVA10)。使用Excel 2007和SPSS18.0软件进行数据收集和统计学分析, 对HFMD进行描述性流行病学分析和病原学特征分析。下载CVA6各基因型代表株的VP1区序列, 用MEGA X软件构建基因进化树, 分析其基因特征。结果共收集到1 531例HFMD病例, EV的阳性率为89.16%(1 365/1 531), EV71、CVA16、CVA6、CVA10和其他EV的检出率分别为1.31%(20/1 531)、32.46%(497/1 531)、38.47%(589/1 531)、5.09%(78/1 531)和11.23%(172/1 531)。HFMD的病原构成在不同临床分型(χ^(2)=46.14, P<0.01)、不同职业(χ^(2)=34.65, P<0.01)、不同年份(χ^(2)=462.86, P<0.01)差异有统计学意义。HFMD患者中, CVA16感染者的年龄比CVA6和CVA10感染者的年龄大(F=6.00, P<0.01)。2019年西安市HFMD的主要病原是CVA16, 2020年和2021年HFMD的主要病原是CVA6。EV阳性病例春夏季主高峰(5—7月)的优势病原为CVA16, 秋季次高峰(9—11月)的优势病原为CVA6。西安市8个区县的优势病原为CVA6, 6个区县的优势病原为CVA16, 1个区县CVA16和CVA6共同流行。基因进化分析表明西安市CVA6为D3a亚型, 分为2个进化分支。结论 2019—2021年西安市HFMD的主要病原是CVA6和CVA16, CVA6的基因型为D3a亚型, 病原构成呈现出明显的人群、时间和地区分布差异。Objective To analyze the etiological and epidemiological characteristics of hand,foot and mouth disease(HFMD)in Xi′an from 2019 to 2021,so as to provide evidence for the prevention and control of HFMD.Methods Stool specimens and anal swabs were collected from patients with HFMD.Enteroviruses(EVs)including enterovirus 71(EV71),coxsackievirus A16(CVA16),CVA6 and CVA10 were detected by RT-PCR.Excel 2007 and SPSS18.0 software were used for data collection and statistical analysis,respectively.The epidemiological data of HFMD cases were analyzed by descriptive epidemiology method.The VP1 gene sequence of the representative strain of each CVA6 genotype was downloaded.Phylogenetic trees were constructed using MEGA X software and the genetic characteristics were analyzed.Results A total of 1531 HFMD cases were involved and 1365 were positive for EVs with a positive rate of 89.16%.The detection rates of EV71,CVA16,CVA6,CVA10 and other EVs were 1.31%(20/1531),32.46%(497/1531),38.47%(589/1531),5.09%(78/1531)and 11.23%(172/1531),respectively.There were significant differences in the pathogen composition in HFMD cases of different clinical types(χ^(2)=46.14,P<0.01)and occupations(χ^(2)=34.65,P<0.01)as well as in different years(χ^(2)=462.86,P<0.01).The average age was greater in patients with CVA16 infection than in those with CVA6 or CVA10 infection(F=6.00,P<0.01).In 2019,the HFMD cases were mainly caused by CVA16,while in 2020 and 2021,the main pathogen was CVA6.Enterovirus-positive cases showed a bimodal distribution with the main peak from May to July and the secondary peak from September to November.CVA16 was the predominant pathogen in spring and summer,and CVA6 was the predominant pathogen in autumn.CVA6 was the dominant pathogen in eight districts and counties of Xi′an;CVA16 was the dominant pathogen in six districts and counties;CVA6 and CVA16 co-circulated in one district.The CVA6 isolates belonged to two evolutionary branches of D3a subtype.Conclusions CVA6 and CVA16 were the prevalent pathogens of HFMD and

关 键 词：手足口病 病原学监测 流行病学特征 

分 类 号：R725.1[医药卫生—儿科] R446.5[医药卫生—临床医学]