四川巴中地区感染肠道病毒71型手足口病患儿流行病学特征及免疫球蛋白水平变化

Epidemiological characteristics and immunoglobulin levels of children with hand,foot and mouth disease infected with enterovirus 71 in Bazhong,Sichuan

目的分析巴中地区肠道病毒71型(enterovirus type 71,EV71)感染手足口病(hand-foot-mouth disease,HFMD)流行病学特征及免疫球蛋白水平变化,为制定有效的干预措施提供理论依据。方法选择巴中地区2018—2020年在定点医院门诊或住院的876例HFMD患儿,根据EV71感染HFMD患儿病情分为普通型组、重症组及危重症组,采用RT-PCR技术检测咽拭子标本,了解肠道病毒类型,分析EV71感染HFMD的流行病学特征;采用免疫比浊法测定血清IgM、IgG和IgA水平。结果2018—2020年巴中地区HFMD患儿EV71阳性557例(63.58%),其中男性315例,女性242例,男性HFMD患儿EV71型占比明显高于女性(χ2=4.028,P<0.05)。EV71型HFMD患儿发病年龄主要集中在1~3岁,占77.78%,多数为散居儿童(62.48%);发病具有明显的季节性,发病高峰主要集中于5~8月。根据HFMD患儿病情分普通型病例407例、重症病例246及危重症病例143例,其中重症和危重症HFMD患儿EV71型占比明显高于普通型HFMD患儿,差异有统计学意义(χ2=16.707,P<0.05)。EV71型HFMD患儿IgM和IgG水平显著高于非EV71型HFMD患儿,lgA水平明显低于非EV71型HFMD患儿(P<0.05);三组IgM水平间差异具有统计学意义(P<0.05);危重症最高,其次为重症和普通型(P<0.05);三组IgG水平间差异具有统计学意义(P<0.05);危重症最高,其次为重症和普通型(P<0.05);三组IgA水平间差异具有统计学意义(P<0.05);普通型最高,其次为重症和危重症(P<0.05)。结论EV71感染能够改变机体的免疫功能,免疫球蛋白水平与HFMD的病情严重程度密切相关,临床检测免疫球蛋白水平有助于病情预测及预后评估。

Objective To analyze the epidemiological characteristics and immunoglobulin level of hand foot mouth disease(HFMD)infected by enterovirus type 71(EV71)in Bazhong area,so as to provide theoretical basis for formulating effective intervention measures.Methods A total of 876 children with HFMD who were outpatients or hospitalized in designated hospitals in Bazhong from 2018 to 2020 were selected.According to the condition of children infected with HFMD by EV71,they were divided into ordinary group,severe group and critical group.Throat swab samples were detected by RT-PCR to understand the types of enterovirus and analyze the epidemiological characteristics of EV71 infected with HFMD;The levels of serum IgM,IgG and IgA were measured by immunoturbidimetry.Results from 2018 to 2020,557 children with HFMD in Bazhong were EV71 positive(63.58%),including 315 males and 242 females.The proportion of EV71 in children with HFMD in males was significantly higher than that in females(χ2=4.028,P<0.05).The onset age of children with EV71 HFMD was mainly 1-3 years old,accounting for 77.78%,and most of them were scattered children(62.48%);The incidence has obvious seasonality,and the incidence peak is mainly concentrated from May to August.According to the condition of HFMD children,there were 407 ordinary cases,246 severe cases and 143 critical cases.The proportion of EV71 in severe and critical HFMD children was significantly higher than that in ordinary HFMD children,the difference was statistically significant(χ2=16.707,P<0.05)。The levels of IgM and IgG in children with EV71 HFMD were significantly higher than those in children with non EV71 HFMD,and the level of LGA was significantly lower than those in children with non EV71 HFMD(P<0.05);There was significant difference in IgM levels among the three groups(P<0.05);Critical illness was the highest,followed by severe and common(P<0.05);There was significant difference in IgG levels among the three groups(P<0.05);Critical illness was the highest,followed by severe and common(P<0.05);There was significant difference in IgA levels among the three groups(P<0.05);The common type was the highest,followed by severe and critical diseases(P<0.05).Conclusion EV71 infection can change the immune function of the body.The level of immunoglobulin is closely related to the severity of HFMD.Clinical detection of immunoglobulin level is helpful to predict the condition and evaluate the prognosis.