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目的采用肠道病毒核酸和抗体检测,分析2015年杭州市手足口病肠道病毒71型(EV71)和柯萨奇病毒A组16型(Cox A16)构成变化及检测方法学评价。方法收集2015年4 8月手足口病患儿663例,采用荧光定量反转录-聚合酶链反应(RT-PCR)检测肠道病毒核酸,采用酶联免疫吸附试验(ELISA)检测血清EV71-Ig M、Cox A16-Ig M。结果663例手足口病患儿通用核酸阳性组58.52%(388/663),EV71组19.16%(127/663),与2014年比较,通用核酸阳性组比例(χ~2=166.306,P=0.000),EV71组比例(χ~2=134.418,P=0.000)差异有统计学意义。手足口病患儿轻症487例,占73.45%,以通用核酸阳性组65.91%(321/487)为主;重症176例,占26.55%,EV71组43.75%(77/176)、通用核酸阳性组38.07%(67/176)位居前2位。不同组别出现重症的比例(χ~2=98.395,P=0.000)差异有统计学意义,EV71出现重症比例最高,为60.63%(77/127)。病毒核酸检测和血清抗体检测阳性率比较差异有统计学意义(χ~2=44.487,P=0.000)。其中,127例EV71阳性患儿,核酸和抗体检测双阳性率为59.85%(76/127),单阳性率为40.15%(51/127);64例Cox A16阳性患儿,核酸和抗体检测双阳性率为9.38%(6/64);单阳性率为90.62%(58/64)。以核酸定量RT-PCR为标准,EV71/Cox A16-Ig M抗体特异度86.61%,敏感度69.49%。结论 2015年与2014年比较,杭州市手足口病病原学流行特征有明显变化。采用病毒核酸和抗体联合检测,可提高实验室的检测阳性率,临床分型有助于辅助指导临床治疗;通用型重症病例增多,需寻找更适合的联合检测方法。
Objective To detect the changes of Enterovirus 71 (EV71) and Cox A16 (Cox A16) in Hangzhou in 2015 with the detection of enterovirus nucleic acid and antibody and to evaluate the methodological evaluation. Methods 663 children with hand-foot-mouth disease were collected from April 2015 to August 2015. The intestine virus nucleic acid was detected by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). Serum EV71- Ig M, Cox A16-Ig M. Results The percentage of common nucleic acid positive group (χ ~ 2 = 166.306, P = 0.000) was 66.5% (388/663) in 663 HFMD patients and 19.16% (127/663) in EV71 patients ), EV71 group (χ ~ 2 = 134.418, P = 0.000), the difference was statistically significant. The number of HFMD patients was 487 (73.45%), with 65.91% (321/487) as the common nucleic acid positive group, 176 severe cases (26.55%), and 43.75% (77/176) in EV71 group Group 38.07% (67/176) in the top two. There was significant difference between the two groups (χ ~ 2 = 98.395, P = 0.000). The highest incidence of severe disease in EV71 was 60.63% (77/127). The positive rates of virus nucleic acid test and serum antibody test were statistically different (χ ~ 2 = 44.487, P = 0.000). Among 127 cases of EV71 positive children, the positive rate of nucleic acid and antibody detection was 59.85% (76/127), the single positive rate was 40.15% (51/127); 64 cases of Cox A16 positive children, The positive rate was 9.38% (6/64). The single positive rate was 90.62% (58/64). The quantitative and qualitative RT-PCR of EV71 / Cox A16-Ig M antibody was 86.61% and the sensitivity was 69.49%. Conclusions Compared with 2014, the epidemiological characteristics of hand, foot and mouth disease in Hangzhou have obvious changes. The combination of viral nucleic acid and antibody detection can improve the positive rate of laboratory tests, clinical classification helps to guide the clinical treatment; general type of severe cases increased, need to find a more suitable joint detection method.