不同标本及组合对荧光探针法诊断儿童手足口病的价值评估

Evaluation on value of different samples and their combination in diagnosis of hand-foot-mouth disease by fluorescence probe method

目的评估不同临床标本及组合在实验室采用荧光探针法诊断儿童手足口病的价值。方法收集680例临床诊断为手足口病的咽拭子和肛拭子标本,其中有溃疡表征的标本223例,有疱疹液的标本522例,有脑膜炎症状的血清和脑脊液标本76例,采用荧光探针法检测肠道病毒肠道病毒71型（EV71）、柯萨奇病毒A组16型（CA16）及通用型。结果单一标本肠道病毒通用型咽拭子阳性检出率（70.29%）最高,其余依次为肛拭子（65.15%）,疱疹拭子（63.03%）,溃疡拭子（43.95%）,脑脊液（2.63%）,血清（1.32%）;对于有全套标本的患儿咽拭子确诊率达74.15%,咽拭子与疱疹拭子组合确诊率达91.7%,咽拭子与肛拭子组合确诊断率为89.26%,全套标本组合将诊断率提升至95.61%;单独一个的疱疹拭子与溃疡拭子诊断率分别为63.03%和43.95%,当疱疹拭子与溃疡拭子为2个诊断率分别为66.67%和47.09%,当疱疹拭子与溃疡拭子为3个诊断率分别为67.24%和47.98%,大于等于4个时诊断率将不再提升。结论对手足口病标本进行实验室检测时,首选咽拭子标本,将咽拭子与其他标本组合将明显提升诊断率;血清和脑脊液标本对临床诊断是否感染手足口病不是必须的选择;对于暴发手足口病采集全套咽拭子、肛拭子、疱疹拭子、溃疡拭子标本十分必要;采集疱疹拭子与溃疡拭子标本时同时采集2~3个拭子是较为可靠的做法。

Objective To evaluate the value of different clinical samples and their combination in the diagnosis of hand-foot-mouth disease（HFMD） by adopting fluorescence probe method. Methods 680 throat swabs and rectal swabs of clinically diagnosed HFMD were collected,in which 223 cases had ulcer symptom,522 cases had herpes liq- uid and 76 cases of serum and cerebrospinal fluid had meningitis symptoms. Then enterovirus EV71,CA16 and uni- versal enterovirus were detected by adopting the fluorescence probe method. Results The positive rate of universal enterovirus in single throat swabs was 70. 29%, showing the highest detection rate, followed by the rectal swab （ 65.15 % ） , herpes swab（ 63.050/00 ）, ulcer swab（ 43.95 %）, cerebrospinal fluid（ 2.63 % ） and serum （ 1.32%） ; the defi- nite diagnosis rate of throat swab with whole set of samples reached 74. 15%, which of the combination of throat swab plus herpes swabs reached 91.7% ,which of the combination of throat swab and rectal swab reached 89.26%, while which of whole set of samples was increased to 95.16% ;the diagnosis rates of single herpes swab and ulcer swab were 63.03% and 43.95% respectively,while which of two herpes swabs and two ulcer swabs were 66.67% and 47.09%respectively,which of three herpes swabs and three ulcer swabs were 67.24% and 47.98% respectively, while which of 4 or more swabs each was not upgraded. Conclusion In conducting the laboratory detection of HFMD samples, the throat swab is the first choice, the combination of throat swab with other samples would significantly in- crease the diagnosis rate; serum and cerebrospinal fluid samples are not necessary choice for clinically diagnosing whether HFMD infection. It is very necessary to collect the whole set of throat swab, rectal swab,herpes swab and ulcer swab for the outbreak of HFMD,simultaneously collecting 2-3 herpes swabs and ulcer swabs is a relatively reli- able way.