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目的:对2010年北京市昌平区手足口病患者及其密切接触者进行肠道病毒病原体检测,分析肠道病毒血清型分布情况。方法:采集医疗机构临床诊断为手足口病患者及重症患者密切接触人群鼻咽拭子及粪便样本,提取病毒核酸,使用人肠道病毒通用引物、肠道病毒71型和柯萨奇病毒A16型特异性引物进行逆转录-聚合酶链式反应(RT-PCR),检测肠道病毒病原体及肠道病毒71型和柯萨奇病毒A16型分布。结果:共采集448份鼻咽拭子及粪便标本,肠道病毒总体检出率为41.74%(187/448),其中肠道病毒EV71型、CoxA16型和未分型肠道病毒阳性检出率分别为21.43%(96/448)、8.48%(38/448)和11.83%(53/448)。比较肠道病毒EV71型和CoxA16型检出率的差异有统计学意义(μ=5.56,μ0.05=1.96,P<0.05)。448份标本中有59份粪便标本,肠道病毒EV71型、CoxA16型和未分型的检出率分别为37.29%(22/59)、3.39%(2/59)和3.39%(2/59)。389份鼻咽拭子标本中肠道病毒EV71型、CoxA16型和未分型的检出率分别为19.02%(74/389)、9.25%(36/389)和13.11%(51/389),比较鼻咽拭子和粪便标本中肠道病毒检出率的差异无统计学意义(μ=0.905,μ0.05=1.96,P>0.05)。临床诊断病例384例,采集鼻咽拭子标本384份,肠道病毒EV71型和CoxA16型检出率分别为17.97%(69/384)和9.90%(38/384)。71例重症病例中采集到标本的病例密切接触者53名,采集标本64份,肠道病毒EV71型和CoxA16型检出率分别为42.19%(27/64)和10.94%(7/64)。比较患者与密切接触者肠道病毒EV71型检出率的差异有统计学意义(2χ=16.02,20χ.05=3.84,P<0.05)。病例发病集中在5月-7月份,以EV71感染为主,病毒感染率以3岁组最高,集中在幼托儿童,男性病毒感染率高于女性。结论:引起北京市昌平区2010年手足口病流行的主要肠道病原体是肠道病毒71型,5岁以下男性儿童是易感人群,密切接触者标本检测到EV71型肠道病毒有助于病例诊断,粪便标本与鼻咽拭子的阳性检出率具有一致性。
OBJECTIVE: To detect enterovirus pathogens in patients with hand-foot-mouth disease and their close contacts in Changping District of Beijing in 2010 and analyze the distribution of enterovirus serotypes. Methods: Nasopharyngeal swabs and faecal samples were collected from clinically diagnosed HFMD patients and critically ill patients in medical institutions. The viral nucleic acids were extracted and used as universal primers for human enterovirus, enterovirus 71 and coxsackievirus A16 Specific primers were used for reverse transcription-polymerase chain reaction (RT-PCR) to detect the distribution of enteroviral pathogens, enterovirus 71 and coxsackievirus A16. Results: A total of 448 nasopharyngeal swabs and stool samples were collected. The overall detection rate of enterovirus was 41.74% (187/448). The positive rates of enterovirus EV71, CoxA16 and undifferentiated enterovirus 21.43% (96/448), 8.48% (38/448) and 11.83% (53/448), respectively. Comparing the detection rates of enterovirus EV71 and CoxA16 with statistical significance (μ = 5.56, μ0.05 = 1.96, P <0.05). Among the 448 samples, 59 samples of stool samples showed positive rates of 37.29% (22/59), 3.39% (2/59) and 3.39% (2/59) for enterovirus EV71, CoxA16 and non-typing, respectively ). The detection rates of enterovirus EV71, CoxA16 and non-typing in 389 nasopharyngeal swab specimens were 19.02% (74/389), 9.25% (36/389) and 13.11% (51/389), respectively There was no significant difference in the detection rate of enterovirus between nasopharyngeal swab and stool samples (μ = 0.905, μ0.05 = 1.96, P> 0.05). 384 cases were diagnosed clinically, and 384 nasopharyngeal swab specimens were collected. The detection rates of enterovirus EV71 and CoxA16 were 17.97% (69/384) and 9.90% (38/384) respectively. Totally 53 cases were collected from 71 severe cases and 64 samples were collected. The detection rates of enterovirus EV71 and CoxA16 were 42.19% (27/64) and 10.94% (7/64) respectively. Comparing the detection rate of enterovirus EV71 between patients and close contacts was statistically significant (2χ = 16.02,20χ.05 = 3.84, P <0.05). The incidence of cases concentrated in May-July, mainly EV71 infection, the highest rate of virus infection in 3-year-old group, focused on child care, male virus infection rate was higher than women. CONCLUSIONS: The main enteric pathogens that caused the HFMD in 2010 in Changping District of Beijing were enterovirus 71, and the male children under 5 years of age were susceptible. EV71 enterovirus was detected in close contact samples to help patients Diagnosis, stool specimens and nasopharyngeal swab positive detection rate is consistent.