武汉地区儿童肠道病毒感染的流行病学及临床特征

Epidemiological and clinical characteristics of enterovirus infection of children in Wuhan city

目的探讨武汉地区儿童肠道病毒的流行病学特征及不同核型肠道病毒感染患儿的临床特征和实验室指标差异,为制定肠道病毒诊疗和防控策略提供依据。方法采集2016-2018年武汉市两家哨点医院(武汉儿童医院、湖北省妇女儿童中心)疑似肠道病毒感染患儿8580例的咽拭子或肛拭子,通过逆转录-聚合酶链反应(Reverse transcription-polymerase chain reaction,RT-PCR)技术进行肠道病毒核酸检测及分型,同时收集患儿的基本信息和临床资料,分析其流行趋势、临床症状、感染指标[白细胞计数(WBC)、中性粒细胞(NEU)、淋巴细胞(LYM)、C-反应蛋白(CRP)、降钙素原(PCT)]、淋巴细胞(CD3^+、CD3^+CD4、CD3^+CD8+、CD4+/CD8+)及免疫指标[免疫球蛋白A(IgA)、IgM、IgG、补体C3、C4]等特征。结果2016-2018年共检出肠道病毒(Enterovirus,EV)阳性884例,阳性率为10.30%(884/8580)。2017年阳性率最高,不同年份阳性率差异有统计学意义(P=0.001)。EV感染具有明显的季节性,5-7月达到高峰,10月又出现一个小高峰。93.33%(825/884)的阳性病例为6岁以内患儿。不同核型的肠道病毒感染的患者除肢体抖动外,其他症状差异无统计学意义,不同核型EV感染患者CRP、CD3^+、CD3^+CD4+T淋巴细胞百分比、补体C3、C4等指标差异有统计学意义(P<0.05)。重症病例患者更易发生高热、腹泻、肢体抖动、呼吸异常、心率增快等症状。重症患儿WBC、NEU、CRP、免疫标记物IgA、IgG、补体C3、C4分别为(12.44±3.92)×10^9/L、(8.58±8.02)×10^9/L、(6.69±8.47)mg/L、(1.01±0.79)g/L、(8.41±2.46)g/L、(1.05±0.37)g/L、(0.59±2.01)g/L均高于轻症患儿(P<0.05),而CD3^+、CD3^+CD4+分别为(40.81±8.18)%、(18.12±6.72)%低于轻症患儿(P<0.001)。结论武汉地区肠道病毒的流行核型已逐渐发生变化,2017、2018年其他肠道病毒基因型已经取代EV-71、Cox A-16成为优势核型。我国仍需继续开展肠道病毒的日常和哨点监测工作,并进一步加强对其他核型的检测,密切关注核型的变化,为提供有针对性的防控与治疗措施提供依据。同时针对其他核型的肠道病毒疫苗的研发工作也刻不容缓。重症病例易引发患者机体免疫功能紊乱,应及早采取干预措施。

OBJECTIVE To explore the epidemiological characteristics of enterovirus and the differences of clinical characteristics and laboratory indexes among children with different karyotypes of enterovirus infection in Wuhan,so as to provide a basis for the diagnosis,treatment,prevention and control of enterovirus.METHODS The throat swabs or anal swabs of 8580children suspected of enterovirus infection in two sentinel hospitals in Wuhan from 2016to 2018were collected.The enterovirus nucleic acid was detected and typed by reverse transcription polymerase chain reaction(RT-PCR).The clinical information of the patients was collected,and the epidemic trend,clinical symptoms,infection indexes such as WBC NEU LYM CRP PCT CD3^+T lymphocytes CD3^+CD4+T lymphocytes CD3^+CD8+T lymphocytes CD4/CD8Tlymphocytes IgA IgG IgM C3C4and other characteristics were analyzed by statistical method.RESULTS A total of 884(10.30%)cases of EV were detected from 2016to 2018,and the positive rate was the highest in 2017(P<0.001).EV infection was seasonal,reaching the peak from May to July,and a small peak appeared in October.93.33%(825/884)of the positive cases were children under 6years old.There was no significant difference in other symptoms except limb jitter in patients with different karyotypes of enterovirus infection.There were significant differences in the percentage of CRP,CD3^+,CD3^+CD4+T lymphocytes,complement C3and C4in patients with different karyotypes EV infection(P<0.05).Severe cases were more likely to have symptoms such as high fever,diarrhea,limb jitter,abnormal respiration,increased heart rate and so on.In severe cases,the levels of WBC,NEU,CRP,IgA,IgG,C3,and C4were(12.44±3.92)×10^9/L,(8.58±8.02)×10^9/L,(6.69± 8.47)mg/L,(1.01±0.79)g/L,(8.41±2.46)g/L,(1.05±0.37)g/L,(0.59±2.01)g/L,were higher than those in mild cases(P<0.05).The levels of CD3^+and CD3^+CD4+were(40.81±8.18)%and(18.12±6.72)%,respectively,which were significantly lower than those in mild children(P<0.001).CONLUTIONS The epidemic karyotype of enterovirus in Wuhan has changed gradually.In 2017and 2018,other enterovirus genotypes have replaced EV-71,Cox-A16as the dominant karyotype.It's necessary to carry out daily and sentinel surveillance of enterovirus,and further strengthen the detection of other karyotypes,and pay close attention to the basis for providing targeted prevention and control and treatment measures.At the same time,the research and development of vaccines for other karyotype enterovirus is also urgent.Severe cases are prone to cause immune dysfunction,and intervention measures should be taken as soon as possible.