2008年上海及周边地区婴幼儿手足口病病原学研究

Etiological study of hand, foot and mouth disease among children in Shanghai and neighbor areas in 2008

目的了解2008年上海及周边地区婴幼儿手足口病病原体分布情况及其基因特征。方法采集2008年5月至6月手足口病流行期间复旦大学附属儿科医院及浙江省德清市住院患儿咽拭标本，部分患儿同时采集脑脊液标本，分别接种于Veto、MRC-5及RD细胞进行病原体分离，RT-PCR检测肠道病毒属、柯萨奇病毒A组16型（CoxA16）、肠道病毒71型（EV71），并对扩增产物测序鉴定。结果100例患儿的107份咽拭和22份脑脊液标本中，共计50例患儿的咽拭标本致细胞病变，经鉴定肠道病毒感染37例，占74．0％，其中EV71为26例，占52．0％（26／50例），CoxA16为10例，占20．0％（10／50例），其他肠道病毒（CoxB3）1例，占2．0％（1／50例）；肠道病毒属外的其他病原体13例，占26．0％，且其中1例患儿的脑脊液标本致Veto细胞病变。所有26例EV71病毒株与2008年中国浙江省及安徽省阜阳市EV71病毒株相似，同属于C基因型；10例CoxA16病毒株均属于C遗传世系。结论手足口病病原复杂，2008年上海及周边地区婴幼儿手足口病的主要病原体仍是EV71和CoxA16，但尚存在一定比例的其他未知病原体。

Objective To investigate the distribution and genetic characteristic of etiological agents among children with hand, foot and mouth disease （HFMD） in Shanghai and neighbor areas in 2008. Methods Throat swabs were collected from the inpatients with HFMD from May to June 2008 in Pediatrics Hospital affiliated to Fudan University, Shanghai, and Deqing, Zhejiang Province. Cerebral spinal fluid （CSF） from some patients were collected as well. Vero, MRC-5 and RD cells were used to isolate the possible pathogens by observing cytopathic effect （CPE）. Enterovirus genus, Coxsackie virus group A type 16 （CoxA16） and enterovirus type 71 （EV71） were detected by reverse transcriptase-polymerase chain reaction （RT PCR）, and finally identified by sequencing. Results A total of 107 swabs and 22 CSF samples were collected from all 100 inpatients. Swabs of 50 children caused CPE observed. Among them, enteroviruses accounted for 74.0% （37/50）, which including 26 （52.0%） of EVT1, 10 （20%） of CoxA16 and 1 （2. 0%） of CoxB3, and 13 （26. 0%） of other pathogens. All the 26 EV71 strains were similar with the isolates from Zhejiang Province and Fuyang, Anhui Province in 2008, which belonged to genotype C; all the 10 CoxA16 strains belonged to genetic lineages C. Conclusions The causative agents of HFMD are complicated. CoxA16 and EV71 are predominant among children with HFMD in Shanghai and neighbor areas in 2008, while the pathogens of some patients are still unknown.