儿童手足口病病原体的检测及致病影响因素研究

Detection of pathogens in children with hand-foot-mouth disease and study on influencing factors of pathogenesis

目的建立快速有效的手足口病病原体检测方法 ,并探讨手足口病病原体在儿童中的影响因素及防控措施。方法选择2015年3~11月在湖北大学医院感染科确诊的手足口病患儿为研究对象,从中随机抽取200例进行研究。本研究采用荧光定量RT-PCR方法对200份手足口病患者标本进行肠道病毒71型(EV71)、柯萨奇病毒普通组16型(CVA16)检测,同时,对病例进行Logistic回归分析来确定危险因素。结果 200例粪便标本检测共检出EV71和CoxA16阳性标本共计153例。其中,普通组感染46例,重型组感染66例,危重型组感染41例。EV71阳性标本感染91例,CoxA16阳性标本共78例。Logistic回归分析显示,在所有调查的影响因素中,体质弱、早产、病例接触史、居住环境差、个人卫生差5个为手足口病危险因素(P<0.05)。结论荧光定量RT-PCR方法具有特异性强,灵敏度高,重复率好的优点,非常适合手足口病病原体的检测;EV71病原体毒力更强,对患儿身体具有更大的破坏性,可引起严重并发症;儿童监护人应为儿童提供一个良好的居住环境和个人卫生,注意儿童膳食营养,避免与手足口病患儿接触,有相关症状应及时入院检查。

Objective To establish a rapid and effective method for the detection of pathogens in hand-foot-mouth disease, and to explore the influencing factors and control measures of hand-foot-mouth disease pathogens in children. Methods 200 patients in children diagnosed with hand-foot-mouth disease in Hubei University Hospital from March to November 2015 were randomly selected. In this study, Enterovirus 71 （EVT1） and Coxsackie virus 16 （CVA16） in 200 hand-foot-mouth disease patients were tested by Quantitative real-time PCR. Logistic regression analysis was also performed to determine the risk factor. Results The results showed that a total of 153 cases of EV71 and CoxA16 positive specimens were detected in 200 stool specimens. Among them, 46 cases of common group infection, 66 cases of heavy group infection, 41 cases of severe group infection. EV71 positive specimens were 91 cases, and CoxA16 positive specimens were 78 cases. Logistic regression analysis showed that among all the influencing factors, the 5 risk factors of hand-foot-mouth disease were poor health, premature delivery, history of contact patient, poor living condition, and poor personal hygiene （P 〈 0.05）. Conclusion The quantitative real-time PCR method has the advantages of strong specificity, high sensitivity and good repeatability, and is very suitable for the detection of pathogens of hand-foot- mouth disease; EV71 pathogen is more virulent and more destructive to the children, and can cause serious complications; children guardians should provide children with a good living environment and a good personal hygiene, pay attention to children＇s nutrition, avoid contact with children with hand-foot-mouth disease, if children have associated symptoms, they should be promptly admitted to hospital.