深圳地区儿童A群致病性链球菌感染流行现状及M蛋白基因分型分析

Analysis of the Prevalence Status and M Protein Gene Classification of A Group Pathogenic Streptococcus Infection of Children in Shenzhen Area

目的：了解深圳地区儿童 A群致病性链球菌（group A streptococcus，GAS）感染流行现状及其 M蛋白基因（emm）分布状况，为该区GAS疫苗的研制提供科学依据。方法收集2014年3月～2015年12月来医院门诊和住院部就诊的急性咽炎、急性化脓性扁桃体炎、风湿热及猩红热患儿的咽拭子及皮肤化脓性感染伤口分泌物共1634例，分别对标本进行细胞培养与鉴定，分析不同年龄儿童 GAS感染流行情况，并对 GAS的 M蛋白 N末端进行 PCR扩增测序，分析 GAS的emm基因分型及其在疾病中的分布情况。结果1634例标本中共分离鉴定出61株 GAS，检出率为3.73％（61／1634），其中学龄前和学龄儿童分别检测出14株和47株，检出率分别为22.95％（14／61）和77.05％（47／61），学龄儿童 GAS感染率明显高于学龄前儿童，两者结果之间差异有统计学意义（χ2＝32.035，P＜0.01），但学龄儿童不同年龄段 GAS感染率之间比较差异无统计学意义（χ2＝1.572，P＞0.05）；GAS 在急性咽炎和化脓性扁桃体炎的患儿中检出率最高，分别为34.43％（21／61）和27.87％（17／61）；61株 GAS的 emm基因型以 emml 和 emm12最为多见，分别占40.98％（25／61）和29.51％（18／61）。结论深圳地区学龄儿童 GAS感染率明显高于学龄前儿童，且以急性咽炎和急性化脓性扁桃体炎患儿检出率最高。61株 GAS感染的 emm基因以emm1和emm12为主，因此，各地加强GAS的emm基因分型研究，可为该区GAS疫苗的研制提供重要的分子流行病学依据。

Objective To understand children in Shenzhen area A group of pathogenic hammer wormwood （group A strepto-coccus,GAS）infection prevalence status and distribution of the M protein gene （emm）,the research provided the scientific basis for the GAS vaccine.Methods Collected 1 634 cases withacute pharyngitis,acute suppurative tonsillitis,rheumatic fe-ver and scarlet fever children＇s throat swab and skin purulent infection wound secretion in the hospital outpatient and the in-patient treatment from March 2014 to December 2015.The specimens were coultured and indentified.The prevalence of GAS infection in children with different age was analyzed,and the M and N of GAS was amplified and sequenced with PCP.Then analyzed the genotyping of GAS emm gene and its distribution in the disease.Results From 1 634 cases of specimens of the communist party of China were identified 61 plants,GAS detection rate was 3.73% （61/1 634）,including preschool and school-age children 14 seedlings,and 47 respectively to detect the detection rate was 22.95% （14/61）and 77.05% （47/6 1 ）,school-age children GAS rate significantly higher than that of preschool children,the difference between the results was statistically significant （χ2=32.035,P〈0.01）,but the school-age children there was no statistically significant difference compare between different age paragraph GAS infections （χ2=1.572,P〉0.05）.GAS in children with acute pharyngitis and suppurative tonsillitis the highest detection rate,were 34.43% （21/61）and 27.87% （17/61）.61 strains of GAS emm geno-types in emml and emm12 most see more,40.98% （25/61）and 29.51% （18/61）.Conclusion School-aged children in shenzhen area GAS rate was significantly higher than that of preschool children,and in children with acute pharyngitis acute suppurative tonsillitis and the highest detection rate.6 1 strains of GAS infection was given priority to with emm1 and emm1 2 emm gene,therefore,strengthen the GAS around the emm genotyping research,could provide important for the development of the GAS in the vaccine molecular epidemiology basis.