滁州市2012～2016年手足口病病原学动态变化分析

Dynamic changes of pathogens of hand,foot and mouth disease in Chuzhou City,2012-2016

目的了解滁州市手足口病病原变化特点,指导临床诊疗工作。方法 2012～2016年按照手足口病监测方案要求,滁州市每个县(市、区)每月抽取5例手足口病患者采集咽拭子标本,重症及死亡病例患者全部采样,对采集的标本使用实时荧光RT-PCR进行肠道病毒核酸检测,包括肠道病毒EV71型(EV71)、柯萨奇病毒A16型(CoxA16)和其他肠道病毒通用型(PE)。结果 2012～2016年滁州市共采集手足口病病例标本2 475份,手足口病肠道病毒核酸总阳性率为43.35%。EV71型、CoxA16型和其他肠道病毒核酸阳性率分别为41.85%、27.49%、30.66%,不同年份阳性率差异有统计学意义(х~2=77.257,P<0.001),其中2013年的阳性率最低,为27.74%,2016年阳性率最高,达到53.05%。2012～2016年阳性率总体呈上升趋势,经趋势卡方检验差异有统计学意义(х~2=20.312,P<0.001)。EV71型占阳性总数的比例下降较明显,其他肠道病毒核酸阳性占阳性总数的比例呈逐渐上升趋势。定远县和天长市的标本手足口病肠道病毒核酸阳性率低于平均水平(43.35%),分别为22.58%和25.63%。阳性检出率从每年4月开始升高,5～7月最高,随后逐渐下降。EV71型在5月和11月阳性检出比例较高,CoxA16型阳性检出比例较高的月份为1～3月,其他肠道病毒阳性比例最高的在12月。结论滁州市手足口病病原学检测总阳性率呈逐年上升趋势,致病病原体近年来主要以其他肠道病毒和CoxA16型为主,不同型别病原体优势月份不同,应根据监测的病原特征助力手足口病防控工作。

Objective To understand the characteristics of the pathogenchanges in hand,foot and mouth disease(HFMD)in Chuzhou City,so as to guide clinical diagnosis and treatment.Methods In 2012-2016,according to the requirements of Hand,Foot and Mouth Disease Surveillance Program,the sampls of throat swab were randomly collected from 5 patients with HFMD every month in every county(including all severe and dead cases)of Chuzhou City.These samples were detected by RT-PCT for enterovirus nucleic acid detection,including enterovirus EV71,CoxA16 and other enterovirus generic types(PE).Results From 2012 to 2016,2 475 samples of HFMD cases were collected in Chuzhou City,with a total positive rate of enterovirus nucleic acid 43.35%.The positive rates of EV71,CoxA16 and PE were 41.85%,27.49%and 30.66%,respectively.There were statistical significance in the different positive rate between 2012 and 2016( x^2=77.257,P<0.001).The lowest positive rate was 27.74%in 2013,and the highest positive rate was 53.05%in 2016.The positive rate showed an upward trend from 2012 to 2016,and the difference was statistically significant by trend chi-square test.(х^2=20.312,P<0.001).The proportion of EV71 in the total number of positive cases decreased significantly,while the propotion of other enterovirus nucleic acid positive cases increased gradually.The positive rate of enterovirus nucleic acid in HFMD of Dingyuan county(22.58%)and Tianchang City(25.63%)was lower than the average level(43.35%).The positive dectation rate began to increase in April every year,and reached a high point from May to July,and then graduallydecreased.The positive rate of EV71 was higher in May and November.The positive rate of CoxA16 was higher from January to March.The positive rate of PE was higher in December.Conclusion The total positive detection rate of HFMD in Chuzhou was increasing year by year,the main pathogens were other enteroviruses and CoxA16,and the dominant types of pathogens were different in different months.HFMD prevention actions should be taken according to the characteristics of the pathogens.