手足口病患儿的病原体研究进展

Research progress on pathogens in children with hand,foot and mouth disease

引起小儿手足口病的病原包括脊髓灰质病毒、埃可病毒、柯萨奇病毒及新型肠道病毒。引发手足口病的常见病原为肠道病毒71型(EV71)及埃可病毒,EV71基因组分型包括VP1、VP2、VP4及5,UTR,其中VP1可决定病毒抗原性,基因多态性明显,根据VP1核苷酸序列可将其分为A、B和C三种基因型,其中B型包括B1~B5型,C型包括C1~C5型,其中C4型在我国EV71型中为绝对优势基因亚型,而其致病因素尚不明确,可能与特异细胞免疫功能水平降低有关。柯萨奇病毒中包括A、B、C三系,具有一定的遗传多样性,其致病机制尚不明确,研究较EV71病毒少,临床上可通过双份血清标本中和抗体滴度、病毒分离培养及逆转录聚合酶链反应检测。目前对于手足口病,临床上缺乏特异性的治疗药物及方法,可通过疫苗注射来预防手足口病,EV71疫苗研发中包括灭活疫苗、DNA疫苗、病毒颗粒疫苗及减毒活疫苗,有待继续研究新的疫苗。本文综述了手足口病患儿的病原体研究进展,以期为临床防治手足口病提供参考。

The pathogens that cause hand,foot and mouth disease in children include spinal cord gray matter virus,echovirous,Coxsackievirus and novel enterovirus.The common pathogens that cause hand,foot and mouth disease are enterovirus 71 type(EV71)and echovirous.The EV71 genome group typing includes VP1,VP2,VP4 and 5,UTR.Among them,VP1 can determine the virus antigenicity,and the gene polymorphism is obvious.According to the VP1 nucleotide sequence,it can be divided into three genotypes A,B and C,among which B type includes B1 to B5 type,C type includes C1 to C5 type,and C4 type is the absolute dominant gene subtype among EV71 types in China.However,its pathogenic factors are not yet clear,and it may be related to the decreased level of specific cellular immune function.Coxsackievirus includes three strains A,B and C,which have certain genetic diversity,its pathogenic mechanism is not yet clear,and there are fewer studies compared to EV71 virus.In clinical practice,it can be detected by neutralizing antibody titers in double serum samples,virus isolation and culture,and reverse transcription polymerase chain reaction.At present,there is a lack of specific therapeutic drugs and methods for hand,foot and mouth disease in clinical practice that can prevent hand,foot and mouth disease through vaccine injection.The development of EV71 vaccines includes inactivated vaccines,DNA vaccines,viral particle vaccines,and attenuated live vaccines,and new vaccines need to be further researched.This article reviews the research progress on pathogens in children with hand,foot and mouth disease,in order to provide reference for clinical prevention and treatment of hand,foot and mouth disease.