手足口病住院患儿的病原学和临床特征

Pathogenic and clinical characteristics of hospitalized children with handfootandmouth disease

摘要:

目的了解手足口病（HFMD）病原体分布情况及流行趋势，为HFMD的防治提供依据。方法调查2015年1—12月某院确诊的HFMD住院患儿，采用实时荧光PCR法对HFMD病例标本进行肠道病毒（EV）通用型、肠道病毒71（EV71）型和柯萨奇A16（CoxA16）型核酸检测。分析不同月份、性别、年龄组、感染类型患儿EV阳性检出率及各型别分布情况。结果2015年共采集837例HFMD患儿咽拭子标本，其中EV阳性标本380份，阳性率为45.40％。病毒分型结果显示：EV71阳性标本110例（28.95％）；CoxA16阳性标本7例（1.84％）；EV71+ CoxA16阳性标本6例（1.58％）；其他EV阳性标本257例（67.63％）。该病从4月份开始进入高发期，5~6月达到最高峰， 7~12月持续高发。不同月份患儿EV阳性检出率比较，差异有统计学意义（P＜0.05）。发病年龄主要集中在3岁以下儿童。不同年龄组患儿EV阳性检出率、EV各型别构成比较，差异均有统计学意义（均P＜0.05）。 重症HFMD病例的EV阳性检出率为65.34%，高于普通病例的27.06%（P＜0.001）。EV71型感染患儿中重症病例比率为90.00%；由其他EV感染所致的患儿中重症病例比率为60.70%；EV71+CoxA16双重感染的患儿全部为重症病例。不同感染类型患儿EV各型别构成比较，差异有统计学意义（P＜0.001）。结论2015年该院收治的HFMD住院患儿的EV感染型别主要以非EV71、非CoxA16的其他EV为主，对高发季节、3岁以下的高发人群及重症病例应高度关注，做好预防和治疗工作。

Abstract:

ObjectiveTo understand the pathogenic distribution and epidemiological trend of handfootandmouth disease (HFMD), and provide evidence for the prevention and control of HFMD. MethodsChildren who were diagnosed with HFMD in a hospital between January and December 2015 were investigated, realtime fluorescence PCR was used to detect enterovirus universal type EV, enterovirus 71 (EV71), and Coxsackievirus A16 (CoxA16) in specimens from children with HFMD. Positive rates and distribution of various types of EV among children of different months, genders, age groups, and infection types were analyzed. ResultsA total of 837 throat swab specimens from HFMD children were collected in 2015, 380 (45.40％) of which were EV positive specimens. Virus typing showed that 110 (28.95%), 7 （1.84％）, 6（1.58％）, and 257（67.63％） were positive specimens for EV71, CoxA16, EV71+CoxA16, and other types of EV.  HFMD had a high prevalence since April, reached a peak in MayJune, and remained high incidence in JulyDecember. Positive rates of EV in children of different months were statistically different (P<0.05). The age of onset was mainly in children under 3 years. Positive rates of EV and constitute ratios of different types of EV in children of different age groups were all statistically different (all P<0.05). The positive rate of EV in severe HFMD cases was higher than common cases (65.34% vs 27.06%, P＜0.001）. The proportion of severe cases in children with EV71 infection and other types of EV infection were 90.00% and 60.70% respectively; children with EV71+CoxA16 double infection were all severe cases. Constitute of EV types in children with different infection types was statistically different(P<0.001). ConclusionIn 2015, EV infection in hospitalized children with HFMD in this hospital was mainly caused by other types of EV (nonEV71 and nonCoxA16), the high prevalence season, highrisk population under 3 years of age, and severe cases should be paid high attention, prevention and treatment should be performed well.