2016-2018河北地区儿童病毒性脑炎流行特征调查

Epidemiological characteristics of viral encephalitis in children in Hebei Province from 2016 to 2018

目的了解河北地区儿童病毒性脑炎病原谱和分子进化特征。方法收集2016-2018年河北地区351例诊断为病毒性脑炎的患儿的临床资料。采用实时荧光定量PCR检测脑脊液中病原,并利用PCR扩增肠道病毒VP1基因序列片段。对柯萨奇病毒B5型测序并利用软件MEGA6.0绘制种系发生树,采用邻位相连法构建进化树。结果351例患者中,学龄前儿童247例占70.37%。其中发热312例、287例头痛.228例呕吐或腹泻.61例咽痛或有呼吸道症状.23例嗜睡、皮疹9例和惊厥3例。351份脑脊液样品中102份样品检测结果为阳性,阳性率29.06%。其中单--感染101例,双重感染1例。102份样本中,检出EVs 72份,VZV 15份,HSV 10份,检出HHV63份,EBV与EV合并感染检出1份。72份肠道病毒样本中全部为肠道病毒B群,未检出肠道病毒A群。31株CVB5、18株Echovirus 30、3株CVB3.3株Echovirus9、2株CVB2.1株CVB1。31株CVB5与其他中国株之间VP1核苷酸同源性90.1%~99.5%,氨基酸同源性92.8%~99.7%;18株Echovirus30与其他中国株之间VP1核苷酸同源性91.6%~98.7%,氨基酸同源性95.3%~99.2%。系统进化分析显示CVB5均在C分枝上。结论发热和头痛是病毒性脑炎患儿的主要临床特征,肠道病毒是主要病原体。CVB5与其他中国株在同一分枝,说明亲缘关系较近。

Objective To ascertain the pathogen spectrum and molecular evolutionary characteristics of viral encephali-tis in children in Hebei Province.Methods Clinical data on 351 children with viral encephalitis in Hebei Province from January 2016 to December 2018 were collected.A real-time fluorescence quantitative polymerase chain reaction was used to detect pathogens in cerebrospinal fluid.The enterovirus VP1 gene was amplified using a polymerase chain reaction.Coxsackievirus type B5 was sequenced,and a phylogenetic tree was constructed using the neighborhood joining method in the software mega6.0.Results Of the 351 pediatric patients,247(70.37%)were preschoolers.Three hundred and twelve of the patients had a fever,287 had a headache,228 had vomiting or diarrhea,61 had pharyngeal pain or respirato-ry symptoms,23 had drowsiness,9 had a rash,and 3 had convulsions.Of 351 CSF samples,102 were positive for a pathogen at a rate of 29.06%。A single infection was found in 101 patients and a double infection was found in 1.EV was detected in 72 of 102 samples,VZV was detected in 15,HSV was detected in 10,HHV was detected in 63,EBV was de-tected in 1,and co-infection with EBV and EV was detected in 1.All 72 samples of enterovirus were group B enterovirus;group B was not detected.There were 31 strains of CVB5,18 strains of Echovirus 30,3 strains of CVB3,3 strains of Echovirus 9,2 strains of CVB2,and 1 strain of CVB1.The nucleotide sirmilarity of VP1 to 31 strains of CVB5 was 90.1-99.5%,and the amino acid similarity of VP1 to those strains was 92.8一99.7%.Phylogenetic analysis indicated that cvb5 was on the C branch.Conclusion A fever and headaches were the main clinical manifestations of viral encephalitis in children,and enterovirus was the main pathogen responsible for that condition.CVB5 strains were on the same branch as other Chinese strains,indicating a relatively close genetic relationship.