手足口病患者体内肠道病毒71型和柯萨奇病毒A组16型与常见呼吸道病毒的检测及临床分析

Detection and clinical analysis of EV71, CA16 and respiratory virus con-infection in patients with hand, foot and mouse disease

目的调查手足口病患者中EV71和CA16的感染现状，分析呼吸道病毒合并感染对患者的影响。方法收集2010年6—10月在北京佑安医院就诊的手足口病患者348例，包括门诊轻症患者100例，住院患者248例。采集患者咽拭子标本提取病毒RNA，用随机引物将标本中的RNA逆转录成cDNA，荧光PCR法检测EV71和CA16。以呼吸道病毒多重PCR引物扩增12种呼吸道病毒的基因片段，通过电泳分析判断结果。比较EV71（＋）或CA16（＋）组与EV71（-）CA16（-）组合并呼吸道病毒感染阳性率和重症患者比例，住院与门诊手足口病患者中合并感染呼吸道病毒的阳性率。结果348例手足口病患者，共检测出呼吸道病毒感染36例。在248例住院手足口病患者中，111例EV71（＋）或CA16（＋）组患者呼吸道病毒感染率7．2％，相比137例EV71（-）CA16（-）组患者呼吸道病毒感染率7．4％，差异无统计学意义（χ2=0．059，P〉0．05）。在100例门诊轻症手足15病患者中，有17例（17％）合并呼吸道病毒感染，高于111例EV71（＋）或CA16（＋）组患者呼吸道病毒感染率，差异有统计学意义（χ2=4．830，P〈0．05）。在111例EV71（＋）或CA16（＋）组中，重症患者为101例（91．0％）；在137例EV71（-）CA16（-）组中，重症患者为132例（96．4％），两组重症患者率差异无统计学意义（χ2=3．099，P〉0．05）。在348份标本中检出占前3位的呼吸道病毒分别是人鼻病毒A／B（HRVA／B）、人副流感病毒3（PIV3）、甲型流感病毒（FLUA）。结论手足口病患者中存在呼吸道病毒合并感染，但合并感染对手足口病病情未见明显影响。

Objective To explore the situation of respiratory virus co-infection with EV71 and CA16 in patients with hand, foot and mouse disease （HFMD）, and analyze the influence of co-infection on clinical aspects. Methods From June to October of 2010, there were 348 patients enrolled in the study, with 248 hospitalization cases and 100 mild outpatients. All the patients were diagnosed as HFMD in Beijing You-an Hospital. The viral RNA from the pharynx swab samples were extracted and reversely transcribed by RT-PCR. All the samples were detected with the EV71 and CA16 by real-time fluorescence quantitative PCR. Twelve kinds of respiratory viruses were detected by a commercial muhiplex-PCR method. The PCR products were confirmed by electrophoresis. Chi square test was used in the data analysis. Results Of the 348 HFMD patients, 36 subjects were detected as positive for respiratory virus co-infection. In the 248 hospitalization cases, 111 cases were positive for EV71 or CA16, with eight cases identified with respiratory virus co-infection （7.2%）; the other 137 cases were negative for EV71 and CA16, with eleven cases identified with respiratory virus co-infection（7.4% ）. There was not significant difference between respiratory virus co-infection and the identification of EV71/CA16 （χ2 =0. 059, P 〉0.05）. In the 100 mild outpatients positive for EV71 or CA16, seventeen cases were identified with respiratory virus co-infection （ 17% ）. The rate of respiratory virus co-infection in the mild outpatients was much higher than in the severe hospitalization patients （χ2 =4. 830, P 〈0. 05）. Among the 111 EV71 （ ＋ ） or CA16（ ＋ ） inpatients, there were 101 cases diagnosed as severe cases（91.0% ） ; similarly, there were 132 cases diagnosed as severe cases （96. 4% ） among the 137 EV71 （ - ）CA16 （ - ） cases. There was not difference between the identification of EV71/ CA16 and illness of HFMD（x2 = 3. 099, P 〉 0. 05 ）. The leading respiratory virus being identified were HRV A/B,PIV3 and FLU A in the 348 HFMD patients. Conclusions Co-infection with respiratory virus exists in the HFMD patients. However, the respiratory virus infection has no significant influence to the state of HFMD illness.