2009年湖南省哨点医院手足口病病原学检测与分析

Etiology Study on Hand-foot-mouth Disease in Surveillance Hospitals of Hunan Province,2009

目的针对2009年湖南瘩哨点医院手足口病（HFMD）实验室检查结果进行分析，为湖南省HFMD的综合防治提供参考资料。方法收集湖南省2009年4—12月份监测哨点医院HFMD病例送检的咽拭子、粪便、疱疹液等标本，用RD、Hep-2细胞进行病毒分离，应用RT—PCR技术检测肠道病毒71型（EVT1）、柯萨奇病毒A组16型（CVA16）、非EV71和CVA16的其它肠道病毒（EV）。结果374例HFMD患者的551份各类样本中EV71病毒、CVA16病毒、EV71和CVA16病毒以及EV的检出率分别为：35．02％、12．30％、0．27％、25．40％。三种不同型别肠道病毒的在全年中交替变更；病例人群男性高于女性（1．99：1），其中1～2岁儿童是病例数和重症病例数最多年龄段；52例HFMD重症病例中，EVT1的检出率高于CVA16（P〈0．01）；对不同类型的阳性标本进行病毒分离，共获67份阳性毒株，包括EV71型43株，CVA16型5株，EV型16株，混合毒株3株（EVT1＋CVA16型1株，EVT1＋EV型1株，CVA16＋EV型1株）。不同类型标本的肠道病毒阳性检出率和阳性检出构成差异均有显著性（P〈0．05），粪便标本的检测阳性率和分离率最高。结论EVT1型是2009年湖南省HFMD流行的主要致病病毒，同时也是引起手足口重症病例和死亡病例的主要毒株类型。

Objective To understand the pathogen characters of hand -foot -mouth disease （HFMD） and provide reference for laboratory diagnosis in Hunan province. Methods During April to December in 2009,374 samples of HFMD cases were collected from surveillance hospitals of Hunan Province, including throat swab, feces,anal swab,herpes fluid,cerebrospinal fluid sample. Nucleic acids of three types of viruses of enterovirus 71 （EV71）, Coxasckie virusA16 （CVA16） and the enterovirus excluding EV71 and CVA16（EV）, were detected by RT -PCR method. Results In 374 samples of HFMD cases, the positive detectable rates of EV71, CVA16, EV71 ＋ CVA16 and EV were 35.02%, 12.30% ,2.67% ,25.4%, respectively. Three types of enterovirus were interchanged from April to December. From the difference of age and gender, the proportion of male and female in the cases of HFMD was 1.99： 1 ; The most severe cases were dominated by the age from one to two. The detectable positive rates of EV71 48.08% was significantly higher than the rate of CVA16 3.85% （ P 〈 0. 001 ） ; 67 postive virus strain were obtained, including 16 strains of EV, 43 strains of EV71,5 strians of CVA16, and 3 mixed virus strains. The positive rate and constituent ratio in different types of sample all had statistical significance （ P 〈 0.05 ）. The feces samples were of highest positive and isolation rate. Conclusion EVT1 was the dominant pathogen of the HFMD in the hospitals of Hunan Province in 2009, and the major enterovirus cansing HFMDsevere cases.