2012年度211例手足口病住院患儿病原学检测及分析

Etiology detection and analysis of 211 cases with hand, foot and mouth disease in 2012

目的：掌握2012年度北京大学北京地坛医院教学医院手足口病住院患儿的病原体分布情况与变化趋势，为手足口病的防治提供科学依据。方法本研究收集北京大学北京地坛医院教学医院儿科2012年度211例手足口病住院患儿的咽拭子标本，提取病毒RNA，采用实时荧光聚合酶链反应（RT-PCR）法，进行肠道病毒（EV）通用型、肠道病毒71（EV71）型和柯萨奇A16（CoxA16）型肠道病毒核酸检测。EV（＋）标本判为EV阳性，EV（＋）EV71（＋）标本判为EV71阳性，EV （＋）CoxA16（＋）标本判为CoxA16阳性，EV（＋）且EV71（-）CoxA16（-）标本判为非EV71非CoxA16型肠道病毒阳性。结果2012年度211例本院手足口病住院患儿中EV阳性标本共118例，占55.92%。病毒分型结果显示，非EV71非CoxA16型肠道病毒阳性标本共46例，占22.81%；EV71阳性标本共45例，占21.32%；CoxA16阳性标本共27例，占12.80%。病原学分布分析结果显示，5～7月份为发病高峰期；不同年龄、性别组患儿之间病原体构成无显著差异；患儿入院前3d肠道病毒检出率较3 d后高；不同型别肠道病毒感染患儿之间平均住院天数差异无统计学意义。结论2012年度本院手足口病住院患儿不同型别EV感染率由高到低依次为：非EV71非CoxA16型肠道病毒、EV71、CoxA16，非EV71非CoxA16型肠道病毒感染率较往年具有升高趋势，尚待进一步研究。

Objective To investigate the distribution and variation of pathogens among pediatric patients with hand, foot and mouth diseases （HFMD） in Beijing Ditan Hospital, Peking University Teaching Hospital, in 2012, and to provide scientific basis for the prevention and treatment of HFMD. Methods Throat swabs of 211 cases hospitalized in Division of Pediatrics, Beijing Ditan Hospital, Peking University Teaching Hospital, in 2012 were collected. Real-time lfuorescence quantitative （RT-PCR） kits with universal enterovirus （EV） primers, Coxsackievirus A16 （CoxA16）-speciifc primers and enterovirus 71 （EV71）-speciifc primers were used to detect the samples after RNA extraction. The samples were identiifed as EV-positive, EV71-positive, CoxA16-positive, if they could be detected with EV primers, EV primers and EV71-speciifc primers, EV primers and CoxA16-speciifc primers, correspondingly. Non-EV71, non-CoxA16 enteroviruses referred to those which could be detected by EV primers, but not by EV71-specific primers or CoxA16-speciifc primers. Results There were 118 enterovirus positive cases among the 211 patients, accounting for 55.92%. Among them, the positive rates of non-EV71, non-CoxA16 enteroviruses, EV71 and CoxA16 were 22.81%（46/211）, 21.32%（45/211） and 12.80%（27/211）, respectively. The peak incidence time of HFMD was from May to July. There were no signiifcant differences between patients grouped by ages or genders in pathogen distribution. The detection positive rate of specimens collected within 3 days after admission was higher than 3 days later. There were no signiifcant differences in the number of hospitalisation days between patients infected by different EVs. Conclusions In 2012, the positive rate of non-EV71 non-CoxA16 enteroviruses was higher than EV71, which was higher than CoxA16 in our study. There was an increasing trend of the positive rate of non-EV71 non-CoxA16 enteroviruses, which deserve future study.