2009-2011年上海市手足口病病原学检测及其临床特点分析

目的 了解上海市手足口病不同病原体的感染现状以及所致的手足口病的临床特点之间的差异,为制定观察、治疗方案,做好手足口病防控工作提供参考.方法 采集2009年3月至2011年12月在本院传染科门诊诊断为手足口病的357例病例的咽拭子、疱疹液、粪便共551份标本进行病原学检测.用RT-PCR法对肠道病毒71型(EV71)、柯萨奇病毒A组16型(CoxA16)、肠道病毒通用型(PE)进行鉴别.结果 357例手足口病患儿共采集到551份标本,检测病毒总阳性率为79.7％,2009年手足口病以CoxA16流行为主,2011年以EV71流行为主,三年病毒流行株差异有统计学意义(P =0.005);疱疹液病毒检出率最高;EV71、CoxA16、PE病毒感染的手足口病患儿在发热、易惊的发生比例比较差异有统计学意义(P＜0.05);EV71感染的患儿外周血白细胞计数和中性粒细胞比例要高于CoxA16和PE感染的患儿,差异有统计学意义(P＜0.05).结论 上海市手足口病在不同时期病原体呈现交替流行;对不同病原体临床特征的分析比较有助于EV71感染的防控、早期治疗、重症病例的筛查.

Detection the pathogens and analysis the clinical characteristics in children with hand, foot and mouth disease in Shanghai during 2009--2011

Objective To investigate the epidemic characteristics of etiological agents and analyze the clinic differences in children with hand,foot and mouth diseases in Shanghai. Methods Collection 551 specimens including vesicle fluid, stool and throat swabs to detect the pathogens. The positive rates were tested by RT-PCR assay with Enterovirus consensus primer and specific primer for Enterovirus 71 （ EV71 ） and Coxsackie A16（CoxA16） , respectively. Results Out of 357 patients, the overall positive rate was 79. 7%. CoxA16 infection was mainly popular in 2009, EV71 was mainly popular in 2011. The epidemic characteristics of enterovirus infection within 2009--2011 had significant differences （P = 0. 005 ）. The positive rate of vesicle fluid was highest. The concurrent rate of fever and tendency to be frightened had significant differences in three patients＇ groups. The count of the peripheral white blood cells and the ratio of the neutrophil in the patients with EV71 infection was higher than that in the patients with CoxA16 or PE infection. Conclusion HFMD showed alternant epidemic characteristics at different times of enterovirus infection in Shanghai. Analyzing the differences of clinic characteristic of EV71 and CoxA16 infection is helpful to prevent and control EV71 infection.