江苏省手足口病病原阳性检出率相关因素及病原学特征

Analysis on etiololgy characteristics and relative factors on positive rate of hand-foot-mouth disease in Jiangsu province

目的:了解江苏省手足口病(Hand-foot-mouth disease,HFMD)肠道病毒阳性检出率相关因素,并对其EV71病毒的VP1基因特征进行分析。方法:在2008年4～12月份,通过监测哨点医院收集全省手足口病病例的咽拭子、粪便或肛拭子、疱疹液、脑脊液、血清标本,并填写病例相关基本信息。结果:共采集手足口病病例的各种类型标本2082份,咽拭子、肛拭子、疱疹液、粪便、脑脊液、血清的总肠道病毒阳性检出率分别为53.52%、41.12%、40.74%、27.27%、25.00%、9.80%,EV71阳性检出率分别为47.03%、30.84%、33.33%、22.73%、25.00%、2.94%,CoxA16阳性检出率分别为5.34%、8.41%、3.70%、0.00%、0.00%、6.68%,不同类型标本的肠道病毒阳性检出率和阳性检出构成均有差异(P值均<0.0001)。总肠道病毒阳性检出率在发病后第2天最高(56.59%),不同发病与采样时间间隔的总肠道病毒阳性检出率和EV71病毒阳性检出率均有统计学意义(P值分别为0.0019、0.0139),而与CoxA16阳性检出率没有统计学意义(P=0.2558)。总肠道病毒阳性检出率在就诊后第2天最高(59.90%),不同就诊与采样时间间隔的总肠道病毒与EV71病毒阳性检出率有统计学差异(P值分别为0.0228、0.0333),与CoxA16阳性检出率没有统计学差异(P=0.3958)。分离的4株EV71病毒均为C4.3基因亚群。结论:标本类型、采样与发病时间间隔、采样与诊断时间间隔均与手足口病病例的肠道病毒阳性检出率密切相关,分离的EV71毒株为C4亚型。

Objective：To understand relative factors contributing to positive rate of enterovirus which result in hand-foot-mouth disease（HFMD）in Jiangsu Province,and analyze the VP1 genetic character of EV71 virus.Methods：During April to December in 2008,2 082 samples of HFMD cases were collected from all surveillance hospital,including throat swab,feces,anal swab,herpes fluid,cerebrospinal fluid,serum sample,and related information was recorded.Results：In 2 082 samples,the positive detectable rates of general enterovirus in throat swab,anal swab,herpes fluid,feces,cerebrospinal fluid,serum were 53.52%,41.12%,40.74%,27.27%, 25.00%,9.80% respectively.The positive detectable rates of EV71 in throat swab,anal swab,herpes fluid,feces,cerebrospinal fluid, serum were 47.03%,30.84%,33.33%,22.73%,25.00%,2.94% respectively,and the positive rates of CoxA16 in throat swab,anal swab, herpes fluid,feces,cerebrospinal fluid,serum were 5.34%,8.41%,3.70%,0.00%,0.00%,6.68% respectively.The positive rate and constituent ratio in different types of sample all had statistical significance（P 〈 0.0001）.The highest positive rate of pan-enterovirus appeared in the next day after onset（56.59%）,and positive rates of pan-enterovirus and EV71 virus in different time-lag between onset and sample collected had statistical significance（P=0.0019,P=0.0139）,while there was no statistical significance compared with that of CoxA16（P=0.2558）.The highest positive rate of pan-enterovirus appeared in the next day after seeing a doctor（59.90%）,and positive rates of panenterovirus and EV71 virus in different time-lag between seeing a doctor and sample collected had statistical significance（P=0.0228,P= 0.0333）,while there was no statistical significance compared with that of CoxA16（P=0.3958）.The isolated EV71 virus belonged to sub-generotype C4.3.Conclusion：Positive rate of enterovirus was closely related to types of sample,time of sample collection,time of seeing a doctor.The identified EV71 virus belonged to generotype C4.