昆明市2008年儿童手足口病的病原学调查

Pathogenesis Survey of Hand,Foot and Mouth Disease in Kunming,2008

目的对昆明市2008年4～6月手足口病流行时期该病患儿进行病原学调查,了解导致本次流行的肠道病毒感染情况.方法采用逆转录聚合酶链反应(RT-PCR)方法,对25例临床诊断为手足口病患儿的咽拭子、疱疹液及尿液标本进行肠道病毒71型和柯萨奇病毒A16型RNA的检测.结果25例患儿共采集58份标本,其中咽拭子21份、疱疹液12份、尿液25份,检测结果13例患儿为CoxA16阳性,阳性率为52%;5例患儿EV71阳性,阳性率为20%;两者之比为2.6:1;咽拭子标本检出率为11/21(52.38%),疱疹液标本检出率9/11(81.82%),尿液标本中未检出病毒.结论所检测2008年昆明市儿童手足口病标本中以CoxA16感染为主,EV71也有散发病例,但未发现重症感染患儿;CoxA16和EV71感染患儿的表现相似,临床难以鉴别;本次实验疱疹液的病毒检出率较高.

Objective Human enterovirus 71 （EV71） and coxsakievirus A16 （CoxAl6） are two major causes of hand-foot-and-mouth disease （HFMD）. Since poliovirus has been eradicated, EVT1 has come to medical attention as the most important enterovirus related to severe complications and sequelae. This study was conducted to investigate the casual causes of HFMD in children during an epidemic from April to June of 2008 in Kunming. Methods 58 specimens that include vesicle fluid, urine and throat swabs, were collected from 25 patients with HFMD. Those suspected people were diagnosed through RT-PCR. Results 13 patients were identified as positive for CoxAl6 and 5 patients were identified as positive for EV71, the rate of CoxA16 and EV71 was 52% and 20% respectively. Conclusions The major causes of HFMD in this epidemic CoxA16 and EVT1, and clinicians can hardly distinguish these two viruses through clinical manifestations. Vesicle swabs give a high diagnostic yield in this study.