2013年新疆维吾尔自治区手足口病病原学检测结果分析

Etiology analysis for hand, foot and mouth disease in Xinjiang in 2013

目的分析2013年新疆维吾尔自治区手足口病的病原构成及病原学特征，为手足口病防控策略的制定提供依据。方法采集2013年1至12月在全疆各级医疗机构就诊的手足口病临床病例标本1287份（粪便1083份，咽拭子204份），采用实时荧光逆转录聚合酶链反应RT．PCR检测肠道病毒（EV）、肠道病毒71型（EV71）及柯萨奇病毒A16（CA16），对109份其他肠道病毒阳性标本进行柯萨奇病毒A6（CA6）和柯萨奇病毒A10（CA10）检测；采用RT—PCR法对6份Ev71阳性标本进行衣壳蛋白VP1（VP1）区全长基因扩增和序列检测，运用生物软件ChromasPr01．7．6，Bioedit7．1．9及MEGA6．06进行核酸序列同源性分析并构建系统进化树。用SPSS17．0软件对不同年龄组患者Ev阳性检出率进行比较分析。结果1287份标本中检出肠道病毒（EV）阳性997份，肠道病毒71型（EV71）、柯萨奇病毒A16型（CA16）及非EV71非CAl6的其他肠道病毒（其他Ev）分别占45．5％（454／997）、13．0％（130／997）和41．4／％（413／997）；不同年龄组患者肠道病毒阳性检出率[7／12～85．1％（137／161）]不同，差异有统计学意义（x2=32．29，P=0．0004），3～5岁组阳性检出率最高（82．5％-85．1％）。109份其他EV阳标本中检出CA6阳性97份，占89．0％，CA10阳性3份，占2．7％；对6株EV71毒株的VP1区全长基因序列的同源性分析结果显示，6株EV71毒株与2008年安徽阜阳及2007年山东临沂毒株的核酸序列有着较高的同源性（95．3％-98．3％），均为c4基因亚型的C4a分支。结论2013年新疆手足口病的病原中其他EV构成比明显上升，与EV71共同成为当年的优势病原。加强手足口病病原学监测，掌握手足口病的病原特点及重要病原的基因变异变迁规律对手足口病防控工作至关重要。

Objective To explore etiological characteristics of hand, foot and mouth disease （HFMD） in Xinjiang in 2013. Methods A total of 1 287 samples of HFMD cases were tested for nucleotide acid of enterovirus （ EV ） , human enterovirus 71 （ EV71 ） , Coxsackievirus A 16 （ CA16 ） , and 109 sample of other EV positive were tested for Coxsackievirus A 6（CA6） and Coxsackievirus A 10 （CA10） by real-time reverse transcription polymerase chain reaction （RT-PCR）. Six EV71 strains were selected to amplify and sequence the whole VP1 region by using RT-PCR, homology were analyzed and phylogenetic tree were constructed by comparison of the sequence with all subgenotype of EVT1 by using software of ChromasProl. 7.6, Bioedit7. 1.9 and MEGA6. 06. EV positive rate in different age groups were compared by SPSS17.0. Results Of all the 1 287 HFMD cases tested, there were 997 EV positive cases, the constituent ratio of EV71 ,CA16 and other EV were 45.5% （454/997） , 13.0% （130/997） and 41.4/% （413/997） respectively. The EV positive rate of different age group [ 7/12 - 85. 1% （ 137/161 ） ] were different significantly （ X2 = 32. 29,P = 0. 000 4） , 3 - 5 age groups had the higher EV positive rate than that of other age groups （82. 5% -85.1% ）. Of all 109 samples of other EV tested, 97 were CA6 （89. 0% ） and 3 were CA10（2.7% ）. Six EV71 strains shared highest nucleotide acid homology of 95.3% -98.3% with the representatives C4a genotype isolated from Fuyang, Anhui Province and Linyi, Shandong Province. Cortelusions The constituent ratio of other EV in HFMD pathogens was increased markedly and became the predominant pathogens with EV71 in 2013. It＇s really important for HFMD control and prevention to enhanee etiological monitoring and understand the characteristics and mutation pattern of pathogens.