2010年昆明及周边地区普通型与重型手足口病病原学分析

Etiological analysis of common and severe hand-foot-mouth disease in kunming and surrounding areas of 2010

目的分析2010年昆明及周边地区手足口病病原体流行情况，深入研究病原体在普通型及重型手足口病引起的临床表现在分子流行病学上的意义。方法采集2010年1月至12月昆明市儿童医院住院的1304倒手足口病惠儿的临床资料，同时将收集到的1272例惠儿的粪便（普通型518例，重型754例）行半巢式RT-PCR核酸检测并测序进行病原体分析。结果在普通型手足口病患儿中共检测到11种病原，柯萨奇病毒A组（CA），CA（60．4％）主要是CAl6所占比例最高，差异有统计学意义（X2=579．78，P〈0．01）。CA（主要是CAl6）为普通型手足口病的主要病原体；在重型手足口病患儿中共检出8种病原，重型手足口病中CA（45．6％）和EV71（29．2％）占的比例较其他病原体比例高，CA（主要是CAl6）和E、叩1是重型手足口病的主要病原体。但CA感染病例52．4％为重型，47．6％为普通型，经x2检验（x2=1．46，P〉0．05），差异无统计学意义。而EV71感染病例70．3％为重型，29．7％为普通型，经X2检验（x2=51．53，P〈0．01），差异有统计学意义。EV71感染手足口病患儿易发展为重型。结论2010昆明及周边地区手足口病患儿的病原检出病原种类多，主要为EV71和CAl6，CAl6为普通型手足口病的主要病原，CAl6和Ewl是重型手足口病的主要病原，但EV71感染手足口病患儿易发展为重症。

Objective To analyze the etiological pathogenesis between common hand-foot-mouth disease （HFMD） and severe HFMD in kunming and surrounding areas of 2010, and study significance of clinical manifestations caused by hand-foot-mouth disease in molecular epidemiology. Methods The clinical data of 1304 children with HFMD in children hospital of Kunming from January to December in 2010 were collected, and at the same time, 1272 cases of stool specimens （518 cases of common HFMD, severe HFMD 754 cases） did half nested RT-PCR detection and nucleic acid sequencing cause credits type. Results Eleven kinds of pathogens were detected in common HFMD cases, coxsackie virus group A （CA）, CA （60. 4% ） （the main CA16 ）was highest proportion. The difference were statistically signifi- cant（~2 = 579.78, P 〈0. 01 ）, CA （mainly CA16） for common HFMD were the main pathogen. In se- vere HFMD cases, 8 kinds of pathogens were detected, the proportion of CA （45.6%） and EV71 （29.2%） were higher than other pathogens, CA （mainly C$16） and EV71 were the main pathogen in severe HFMD. But CA infection case of 52.4% were severe, 47.6% were the common type, the differ- ence had no statistically significant （ X2 = 1.46, P 〉 O. 05 ）. While the EV71 infection rate 70. 3 % was severe type, 29.7% was common type, the difference was statistical significant（ X2 = 51.53, P 〈 0. 01 ）, EV71 infection in children with HFMD likely to develop into severe HFMD. Conclusions Many kinds of pathogens are detected in Kunming and the surrounding areas of children with HFMD in 2010, but main pathogens are EV71 and CA16, CA16 is the main pathogens of common HFMD, CA16 and EV71 are the main pathogens of severe HFMD. But EV71 infection in children with HFMD likely to develop in- to severe HFMD.