2009-2016年瑞安市非EV71和CVA16手足口病病原谱研究

目的 对瑞安市非EV71和CVA16手足口病病原谱进行研究,为临床诊断、治疗和疾病预防控制提供参考。 方法 回顾性分析瑞安市2009年1月-2016年12月期间诊治的2 100份手足口病临床病例样本资料,采用荧光定量PCR法对手足口病病毒核酸进行分型检测及序列测定,采用ClustalX 2软件对CVA6和CVA10病毒基因 VP1序列进行分析。 结果 2009-2016年瑞安市手足口病患者2 100份样本检出1 172株EV71、518株CVA16、191株CVA6、192株CVA10,分别占55.8%、24.7%、9.1%、9.1%。各年度手足口病患者感染EV71、CVA16、CVA6、CVA10及其他病原的相对比例差异无统计学意义(P>0.05)。CVA6、CVA10和其他病原体的构成在不同性别、不同年龄手足口病患者中差异有统计学意义(P<0.01),男性患者中CVA10感染的比例(53.4%)最高而女性患者中其他病原菌感染比例(51.9%)最高,各病原菌主要感染5岁以下患者(CVA6:93.7%,CVA10:96.4%,其他病原体:74.1%);CVA6和CVA10及其他类型病原感染导致重症和死亡的比例为6.3%(12/191)、7.3%(14/192)和7.4%(2/27),三者之间差异无统计学意义(P>0.05)。与Gdula株相比,52株CVA6 VP1区基因核苷酸序列差异为14.6%~17.7%,氨基酸序列差异为3.7%~5.4%,67株CVA10 VP1区核苷酸序列差异为8.8%~12.7%,氨基酸序列差异为2.7%~6.5%。 结论 2009-2016年瑞安市非EV71和CVA16手足口病病原谱以CVA6和CVA10为主,主要感染5岁以下患儿,且具有较高的重症和死亡病例比例。

Pathogenic spectrum of non-EV71, non-CAl6 virus strains of hand,foot and mouth disease in Ruian City, 2009-2016

Objective To analyze the pathogen spectrum of non-EV71, non-CAl6 virus strains of hand, foot and mouth disease (HFMD) in Ruian City, 2009-2016, so as to provide reference for its clinical diagnosis, treatment and prevention and control. Methods Totally, 2,100 clinical specimens of HFMD patients were collected in Ruian City from January 2009 to December 2016, and were subeject to genotyping and sequencing by real-time PCR. The VP1 sequences of coxsackievirus A6(CVA6)and CVA10 genes were assayed by ClustalX2 software. Results Among the 2,100 specimens, enterouvirus 71 (EV71) were detected in 1,172 (55.8%), CVA16 in 518 (24.7%), CVA6 in 191 (9.1%) and CVA10 in 192 (9.1%). The constituent ratios of EV71, CVA16, CVA6, CVA10 and other pathogens showed no statistical differences among 2009-2016 (P>0.05). The constituent ratios of CVA6 , CVA10 and other pathogens showed statistical differences between males and females and among patients with differen age. The proportion of CVA10 was higher in male patients (53.4%) than in female ones (51.69%). The infected patients were mainly children under 5 years of age (CVA6 :93.7%,CVA10 : 96.4%, other pathogens:74.1%). The severe infection and death due to CVA6, CVA10 and other pathogens acounted for 6.3%(12/191), 7.3% (14/192)and 7.4%(2/27), showing no statistical difference (P>0.05). The variances of nucleotide and amino acids in VP1 regions of 52 CVA6 strains were 14.6-17.7% and 3.7-5.4% while those in 67 strains of CVA10 VP1 were 8.8-12.7% and 2.7-6.5%. Conclusions CVA6 and CVA10 were the main pathogens of non-EV71, non-CAl6 virus strains of HFMD in Ruian City in 2009-2016. Both pathogens mainly infected children under 5 years of age, and led to high incidence of severe cases and deaths.