普通型手足口病患儿肠道病毒病原学检测及其临床特点

Pathogen detection and its clinical characteristics of children with ordinary hand,foot and mouth disease

目的探讨普通型手足口病（HFMD）患儿一般临床特点及其肠道病毒（EV）血清型分布特点,揭示普通型HFMD的流行特征。方法选择2014年3~9月于成都市妇女儿童中心医院门诊就诊,临床诊断为普通型HFMD的193例患儿为研究对象。其中,103例取得家长同意后咽拭子取样,采用实时荧光聚合酶链反应（RT-PCR）法进行EV检测,并鉴别其血清型。分析普通型HFMD患儿临床特点,并统计学比较柯萨奇病毒（Cox）A16、EV71及其他EV感染的临床特点差异。本研究遵循的程序符合成都市妇女儿童中心医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象监护人知情同意,并与之签署临床研究知情同意书。结果 1本组193例普通型HFMD患儿中,年龄1~3岁为118例（61.1%）,1~5岁为167例（86.5%）;散居儿童为119例（61.7%）;所有受试者均有咽峡部和（或）口腔疱疹,以及手部、足部和（或）臀部皮疹的临床表现,并预后良好。2本组103例HFMD患儿咽拭子样本EV阳性检出率为86.4%（89/103）;89例EV阳性普通型HFMD患儿中,CoxA16阳性为57例（64.0%）,EV71阳性为16例（18.0%）,其他EV阳性为16例（18.0%）。3本组89例EV阳性普通型HFMD患儿不同血清型病例的年龄、性别构成比、生活范围构成比及变态反应史阳性率等一般临床资料比较,发热率、发热高峰温度、发热持续时间及并发症发生率等临床表现比较,以及白细胞计数及C反应蛋白（CRP）含量实验室等检查结果比较,差异均无统计学意义（P〉0.05）。结论 CoxA16是2014年成都市妇女儿童中心医院普通型HFMD的主要病原体。尚不能根据患儿的主要临床表现及特点,以及外周血白细胞计数和CRP含量检测结果推测可能的EV血清型。

Objective To investigate the characteristics of general clinic data of children with ordinary hand,foot and mouth disease（HFMD）and the serotype distribution of enterovirus（EV）detection results,and to explore the epidemiological characteristics of ordinary HFMD.Methods From March to September,2014,a total of 193 children who were diagnosed as ordinary HFMD in department of clinic service,Chengdu Women and children′s Central Hospital,were chosen as study objects.The throat swab samples from the 103 children with their parents′permission,were collected and analyzed by real-time fluorescence polymerase chain reaction（RT-PCR）to get the EV serotypes.Clinical characteristics of 193 children with ordinary HFMD were summarized and compared the clinical characteristic differences among infection of Coxsackie virus（Cox）A16,EV71 and other EV by statistical method.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Chengdu Women and children′s Central Hospital.Informed consent was obtained from the parents of each participant.Results 1Among 193 children with ordinary HFMD,118cases（61.1%）were 1-3years old,167cases（86.5%）were 1-5years old;119cases（61.7%）were scattered children.Oral mucosal pox or ulcer as well as hand,foot and buttocks rashes were observed in all 193 children,and the prognosis were good for all subjects.2The EV positive detection rate of throat swab samples of 103 ordinary HFMD children was 86.4%（89/103）.Among the 89 ordinary HFMD children with EV positive,57cases（18.0%）were CoxA16 positive,16cases（18.0%）were EV71 positive,and16cases（18.0%）left were other EV positive.3Among the 89 ordinary HFMD children with EV positive,there were no significant differences among infection of CoxA16,EV71 and other EV in general clinic data such as the age,constituent ratio of gender and living range,positive rate of allergy history,etc.;Or in the clinical manifestations of fever rate,peak temperature,fever lasting time and incidence of complications;Also in laboratory examination such as white blood cell count and C-reactive protein（CRP）,etc.（P0.05）.Conclusions CoxA16 infection was the main pathogen of ordinary HFMD in Chengdu Women and children′s Central Hospital in 2014.The characteristics of clinical manifestations,white blood cell count and CRP content results of ordinary HFMD children can not speculated the possible serotype of EV.