泰安市2010～2012年手足口病不同标本检测结果分析

Analysis and pathogenic diagnosis of the hand-foot-mouth diseases of different specimens in Taian from 2010 to 2012

目的对2010～2012年度泰安市手足口病(hand-foot-mouth disease,HFMD)病例的不同标本进行病原体检测和分析,了解本区域HFMD感染状况。方法对临床诊断为手足口病病例的粪便标本1356份、咽拭子68份、脑脊液156份,用RT-PCR和实时荧光定量PCR检测肠道通用病毒(PE)、CVA16和EV71,病人的急性期血清采用酶联免疫吸附试验(ElISA)检测EV71和CVA16的IgM抗体。结果粪便标本肠道病毒总阳性率为81.86%(1110/1356),CVA16阳性率为37.17%(504/1356),EV71阳性率为25.66%(348/1356),其他肠道病毒为19.03%(258/1356),CVA16的阳性率高于EV71。粪便标本的肠道病毒阳性率高于咽拭子的39.70%(27/68)(χ2=27.05,P<0.01)。发病年龄多为1～5岁,主要集中在3岁左右,男性略多于女性,脑脊液的检出率较低,总阳性率为7.69%。对病例的急性期血清进行酶免检测,EV71和CVA16的阳性率分别为28.57%(28/98)和33.57%(33/98),和粪便标本的核酸检测相比较,有较高的相关性。结论 2010～2012年度本区域的手足口病疫情以CVA16为主,粪便标本的阳性率较高,急性期血清的免疫试验结果和分子生物学相符,采用分子生物学方法检测手足口病的病原体,用ElISA检测血清抗体,对手足口病的诊断有重要作用。

Objective： To analyze the pathogenic diagnosis of the hand-foot-mouth diseases（HFMD） of different specimens in Taian from 2010 to 2012,and to understand the status of infection of HFMD in Taian.Methods： A total of 1356 feces specimens,68 throat swabs specimens and 156 cerbrospinal fluid（CSF） specimens from clinically-diagnosed HFMD patients were collected and tested,and Pan-enterovirus,Coxsackie A16（CA16） and Enterovirus 71（EV71） were detemined by RT-PCR and Real-time PCR with species-special primers.The acute phase serum was used to test the IgM antibody by ELISA.Results： Positive rate of Pan-enterovirus,CA16 and EV71 of feces specimens were 81.86%（1110 /1356）,37.17%（504 /1356） and 25.66%（348 /1356） respectively.Positive rate of other enterovirus was 19.03%（258 / 1356）.And the positive rate of CA16 was higher than that of EV71.The positive rate of feces specimens was higher than that of throat swabs specimens（39.70%,27 /68）（χ2 = 27.05,P 0.01）.The age of onset was mostly from 1 to 5 years old.The male prevalence rate was higher than that of the female.Positive rate CSF was 7.69%.The positive rate of IgM antibody of EV71 and CA16 was 28.57%（28 /98） and 33.57%（33 /98）.There was a higher correlation compared with nucleic acid test of feces specimens.Conclusion： CA16 is the dominant pathogen of the HFMD in Taian from 2010 to2012.The feces specimens have a higher positive rate.The immune test results of acute phase serum correspond to molecular biological test results.Molecular biological methods of pathogenic diagnosis and the test of IgM by ELISA play an important role in the diagnosis of HFMD.