感染肠道病毒71型手足口病患儿粪便排毒时间及病毒载量的相关因素研究

Viral load and the duration of virus shedding of enterviru 71 in stool samples of children with hand,food and mouth disease and its related factors

目的：通过连续性监测EV71病毒核酸,研究手足口病患儿感染EV71病毒后在粪便中的排毒时间、病毒载量及其相关因素。方法：观察45例EV71患儿12周,及非EV71组27例作为对照。每隔7 d收集粪便1次,采用real-time PCR Taq Man探针法定量检测病毒核酸。并用Kaplan-Meier生存分析法进行数据分析。结果：57例（79.2%）患儿为持续排毒（EV71 39例,非EV7118例）,有15例（20.8%）为间歇排毒（EV71组6例,非EV71组9例）。在持续性排毒中,EV71组患儿在第1-7周病毒核酸阳性率均为100%,第8-12周分别为94.4%、91.2%、81.6%、81.6%、81.6%,非EV71组在第1-10周病毒核酸阳性率分别为100%、88.9%、83.3%、72.2%、55.5%、23.2%、38.9%、22.2%、14.8%、14.8%、14.8%。这2组粪便核酸阳性率分布有统计学差异（t=4.00,P=0.00）。EV71组与非EV71组患儿的病毒载量在第9周有统计学意义（Z=-2.17,P=0.03）。EV71与非EV71重症组、EV71与非EV71普通组及EV71普通组与重症组患儿的病毒载量在各随访时间内均无统计学意义（P〉0.05）。EV71组患儿病毒载量在年龄和性别上均无统计学差异（χ-2=3.15,P=0.21;Z=-0.03,P=0.98）。结论：手足口病患儿多数为持续排毒,可持续12周以上,EV71组排毒时间长于非EV71组;但EV71组病毒载量低于非EV71组。EV71组病毒载量与年龄和性别无关。

Objective：To study entervirus 71（EV71） virus viral load and shedding period in stool samples of children with hand,food and mouth disease（HFMD） and its related factors. Methods：Forty five HFMD children infected with EV71 for a 12-week follow-up were included in the study as EV71 group. Another 27 HFMD cases infected with other enterovirus were involved as control group.Stool samples for each patient were collected every 7 days and Taq Man probe real-time fluorescent quantitative PCR（RT-PCR） was conducted to detect EV71 virus load. Statistical analysis was performed based on Kplan-Meier method. Results：Fifty seven cases（79.2%） showed persistently detoxifying（39 in EV71 group and 18 in control group）,and 15 cases（20.8%） showed intermittently detoxifying（6 in EV71 group and 9 in control group）. In 57 cases with persistently detoxification,the positive rates of EV71 in EV71 group were 100% from 1 to 7 weeks,and for 8 to 12 weeks the positive rates were 94.4%,91.2%,81.6%,81.6%,and 81.6%,respectively. The positive rates in the control group from 1 to 10 weeks were 100%,88.9%,83.3%,72.2%,55.5%,23.2%,38.9%,22.2%,14.8%,22.2% and 14.8%,respectively. The EV71 positive rates of samples obtained from patients between EV71 and control groups distributed statistically different（t=4.00,P=0.00）. A significant difference was identified in the virus load between EV71 and control groups in week 9（Z=-2.17,P=0.03）. No significant difference in virus load was found between EV71 and control cases in either severe or mild patients,as well as between serve and mild patients in EV71 group during the 12-week follow-up（P 0.05）. No significant difference in the distribution of virus load was identified among different age groups and between male and female among patients infected with EV71（ χ-2=3.15,P=0.21;Z=-0.03,P=0.98）. Conclusion：Consistently detoxification is exhibited in the majority of children with HFMD for over 12 weeks. The viral shedding period of patients is longer in EV71 group than in control group. However,the viral load in EV71 group is lower than in control group. In EV71 group,age and sex are not significantly associated with viral load.