深圳237例手足口病肠道病毒血清型基因及临床特征

Serum types of enterovirus and clinical characteristics of 237 children with hand,foot and mouth disease in Shenzhen

目的了解该地区手足口病临床和流行病学特征,明确其肠道病毒血清型分布。方法分别在肠道病毒基因组5′端非编码区,CAV16和EV71VP1区设计通用引物和特异性引物,建立RT-nPCR检测方法,对手足口病病人进行肠道病毒基因检测,鉴别其血清型,根据血清型不同比较其临床特征。结果237例手足口病均有口腔黏膜疹和手足皮疹,发热141例(59.5%),低热为主,6岁以下占94.5%,以春夏季节为多(67.9%)。肠道病毒通用引物RT-nPCR检测阳性133例(56.1%),其中EV7138例,CAV1664例,二者均阴性31例。12株肠道病毒PCR阳性产物基因克隆、测序,证实分别为EV715株、CAV165株、ECHO131株、CAV51株。结论手足口病病原体以EV71和CAV16为主,另有CAV5,ECHO13,临床症状与肠道病毒血清型关系不大。

Objective To study the clinical and epidemiologic characteristics and the serum types of enterovirus of hand, foot and mouth disease （HFMD） in children. Methods The RT-nPCR method was established with universal primers within 5＇untranslated region of enterovirus and VP1 region of Coxsackievirus A16 （CAV16） and enterovirus 71 （EV 71 ）. Enteroviruses were detected with RT-nPCR in 237 children with HFMD. Clinical and epidemiologic characteristics and serum types of enterovirus of the patients with HFMD were studied. Results The patients＇age ranged from 7 months to 11 years （ mean 4.2 ±0.5 years）. The majority （94.5%） were less than 6 years old. HFMD was mostly seen in spring and winter （67.9%）. Oral mucosal pox or ulcer as well as hand and foot rashes were observed in all 237 patients. Fever occurred in 141 patients （59.5%）. Of the 237 patients, 133 （56.1%） were RT-nPCR positive. Of the 133 cases, 38 were positive for EV71,64 were positive for CAV16, and 31 were negative for both EV71 and CAV16. The patients infected by different types of enteroviruses had similar clinical characteristics. Gene colon and sequence analysis for 12 strains of enteroviruses PCR positive products presented as EV71 （ n = 5 ）, CAV16 （ n = 5 ）, ECHO13 （ n = 1 ）, and CAV5 （ n = 1 ）. Conclusions HFMD tends to occur in younger children less than 6 years old. The majority are affected in spring and winter. EV71 and CAV16 are common pathogens of HFMD. There is no relationship between clinical characteristics and serum types of enteroviruses in HFMD patients.