多重荧光RT-PCR快速检测手足口病病原体的结果分析

目的了解嘉兴地区手足口病（HFMD）的病原学类型及流行特征，为预防和临床诊治提供参考。方法选取2017年1月至12月确诊的HFMD患者743例，采用自建的多重荧光RT-PCR方法对HFMD患者咽拭子标本进行肠道病毒通用型、肠道病毒EV71型和CA16进行检测，比较HFMD患儿不同肠道病毒感染类型与季节、患儿性别和年龄、临床分类等方面的关系。结果743例HFMD患者标本肠道病毒EV／EV71／CA16检测，其中EV71（＋）占237％（176／743），CA16（＋）占20．9％（155／743），非EV71非CA16肠道病毒感染占55．1％（410／743）；混合感染2例。重症HFMD患者与普通HFMD患者之间肠道病毒株流行分布特征差异有统计学意义（χ2=235．939，P=0．000），HFMD重症病例EV71阳性率78．1％（89／114），明显高于普通病例13．8％（87／629）。不同季节HFMD肠道病毒感染分布不一，二、三季度为全年发病高峰期。743例HFMD患儿发病年龄以0~5岁婴幼儿为主，占总感染人数的88.6％；743例HFMD不同肠道病毒感染人数分布与患儿性别间的差异无统计学意义（P=0．896）。结论HFMD患者肠道病毒感染在不同季节、不同年龄流行特点不一，重症HFMD仍以EV71病毒株感染为主；20174嘉兴地区HFMD肠道病毒感染以非EV71非CA16型肠道病毒株为主，有必要进一步明确病毒类型并加强监控。

Objective The aim of this study is to investigate the etiological types and epidemic characteristics of hand, foot and mouth disease （ HFMD ） in Jiaxing, and provide reference for prevention, clinical diagnosis and treatment of HFMD. Methods Seven hundred and forty-three HFMD patients diagnosed by infections department of Jiaxing First Hospital during January 2017 to December 2017 were collected in this study. To compare the relationship between different types of enterovims infection and season, sex, age and HFMD clinical classification of children with HFMD. A self-constructed multiple fluorescence RT-PCR method was used to detect the general, EV71 and CA16 type of enterovims in the swab specimens of patients with HFMD. Results Among the 743 HFMD patients, 23.7% patients （ 176/743 ） were EV71 infected, 20.9% patients （ 155/743 ） CA16 infected, and 55.1% patients （ 410/743 ） were neither EV71 infected nor CA6 infected, and 2 patients were both infected. There were significant differences in the distribution characteristics of enterovirus strains between severe HFMD patients and common HFMD patients （P=0.000） . The positive rate of EV71 was 78.1% （ 89/114 ） in severe cases of HFMD, which was significantly higher than that of normal cases which was only13.8% （ 87/629 ） .The distribution of enterovims infection of HFMD patients in different seasons was not the same, and the second or the third quarter were the peak period of the year. The age of 743 children with HFMD was mainly 0-5 years old, which were 88.6% of the total number of infections. There was no statistical difference between the distribution of the number of different enterovims infections and the sex in the 743 cases of HFMD （P=0.896） . Conclusions The prevalence of enterovirus infection in patients with HFMD varies in different seasons and ages of patients. The severe HFMD patients were still mainly infected by EV71 virus. The HFMD patients were mostly infected by non EV71 non CA16 enterovirus strains during the year 2017 in Jiaxing. It is necessary to further clarify the virus types and strengthen the monitoring.