2013至2014年度首都医科大学附属北京地坛医院手足口病住院患儿的病原学检测分析

Etiology detection and analysis of hand,foot and mouth disease in Beijing Ditan Hospital,Capital Medical University,2013-2014

目的 探讨2013至2014年度首都医科大学附属北京地坛医院儿科手足口病住院患者的病原体分布情况,为手足口病的临床诊断、治疗及预防提供依据。方法 本研究共收集2013至2014年本院收治的232例儿科手足口病住院患者的咽拭子标本,提取病毒RNA,使用肠道病毒（EV）通用型、肠道病毒71（EV71）型及柯萨奇病毒A16（CoxA16）型核酸检测试剂盒,采用实时荧光聚合酶链反应（RT-PCR）法进行检测。结果2013年5-7月手足口病病例数最多,占全年的64.96%（76/117）,2014年手足口病病例则主要集中在6-8月,占全年68.70%（79/115）。2013年手足口病患者的EV阳性率为81.20%（95/11 7）,其中非EV71非CoxA16型肠道病毒占63.25%（74/117）;2014年手足口病患者的EV阳性率为79.1 3%（91/11 5）,其中,EV71型肠道病毒占53.91%（62/11 5）。0-1岁组EV71感染率低于〉1岁组儿童（χ^2=5.22、P=0.022）,而该组非EV71非CoxA16型肠道病毒的感染率高于〉1岁组儿童（χ^2=5.38、P=0.020）,差异具有统计学意义;不同性别组患者病原学构成差异无显著统计学意义。EV71型、CoxA16型及非EV71非CoxA16型病原体感染的住院天数中位数分别为8、7和7 d,EV71感染者住院天数大于CoxA16感染者（Z=-7.27,P〈0.001）及非EV71非CoxA16感染者（Z=-7.39,JP〈0.001）,差异具有统计学意义。结论2013至2014年本院手足口病以夏季高发;2013年本院儿科手足口病患者以非EV71非CoxA16型肠道病毒为主,2014年发生较大改变,以EV71型为主;EV71型肠道病毒感染以〉1岁组儿童为主,而非EV71非CoxA16型肠道病毒感染以0-1岁组儿童为主;EV71型肠道病毒感染者平均住院天数大于CoxA16型和非EV71非CoxA16型。

Objective To investigate the distribution of pathogens among pediatric patients with hand,foot and mouth diseases（HFMD） in Beijing Ditan Hospital,Capital Medical University,from 2013 to2014.Methods The throat swabs of 232 patients in Division of Pediatrics from 2013 to 2014 were collected.Virus RNA was tested by real-time fluorescence quantitative（RT-PCR） kits with universal enterovirus（EV） primers,Coxsackievirus A16（CoxA 16）-specific primers and enterovirus 71（EV71）-specific primers.Results The peak incidence time of HFMD in 2013 was from May to July,accounting for 64.96%（76/117）;and the peak incidence time of in 2014 was from June to August,accounting for 68.70%（79/115）.In 2013,the positive rate of EV was 81.20%）（95/117）,with non-EV71 and non-CoxA16 enteroviruses accounting for 63.25%（74/117）;and in 2014,the positive rate of EV was 79.13%（91/115）,with the EV71 accounting for 53.91%（62/115）.The 0-1-years-old patients were harder to be infected by EV71（χ^2= 5.22,P = 0.022）and easier to be infected by non-EV71 and non-CoxA16 enteroviruses（χ^2 = 5.38,P = 0.020） than other children.There were no significant differences between patients grouped by genders in pathogen distribution.EV71 infected patients hospitalized longer than patients infected with CoxA16（Z=-7.27,P 0.001） and non-EV71,non-CoxA16 enteroviruses（Z =-7.39,P 0.001）.Conclusions The peak incidence time of HFMD was in summer from 2013 to 2014.The main prevalent type in 2013 was non-EV71,non-CoxA16 enteroviruses,but in 2014,the EV71 prevailed again.The 0-1-years-old patients were harder to be infected by EV71 and easier to be infected by non-EV71 and non-CoxA16 enteroviruses than other children.EV71 infected patients hospitalized longer than others.