陈健明 陈胜棣 黄绮云 孔卫乾

【摘要】目的探討手足口病患儿的肠道病毒核酸转阴时间，寻找手足口病的传播规律。 方法 收集临床确诊手足口病患儿，采集患儿的咽拭子、唾液及粪便样本，采用荧光定量PCR技术筛选出肠道病毒71（EV71）、柯萨奇病毒A组16型（CoxA16）核酸阳性的58例患儿，随后根据病毒类型及疾病严重程度，将研究对象分为EV71轻症组、EV71重症组、CoxA16轻症组、CoxA16重症组，分析4组患儿3种样本的肠道病毒核酸转阴情况。 结果58例手足患儿中， EV71阳性38例（66%），CoxA16阳性20例（34%）。EV71阳性者中，轻症20例、重症18例；CoxA16阳性者中，轻症11例、重症9例。EV71患儿的粪便样本最长排毒时间为63 d，CoxA16患儿的粪便样本最长排毒时间为42 d。EV71及CoxA16重症组患儿的粪便样本在起病后的肠道病毒核酸转阴时间均长于同组的咽拭子和唾液样本（P均<005）。EV71及CoxA16轻症组的粪便、咽拭子、唾液样本肠道病毒核酸转阴时间均短于重症组对应的样本（P均<005）。结论手足口病患儿排毒时间与疾病严重程度相关，病情越严重其排毒时间越长。疾病早期应采集3类样本同时进行检测，疾病后期应重点对粪便样本进行检测。

【关键词】手足口病；咽拭子；唾液；粪便；病毒核酸；转阴时间

Study of negativeconversion time of enterovirus nucleic acids in children with handfootmouth disease Chen Jianming， Chen Shengdi， Huang Qiyun， Kong Weiqian Department of Pediatrics， Panyu Central Hospital， Guangzhou 511400， China

Corresponding author，Chen Jianming， Email：13662378012@163com

【Abstract】ObjectiveTo explore the time of negative conversion of enterovirus nucleic acids in children with handfootmouth disease and to investigate the transmission pattern of handfootmouth disease（HFMD） MethodsFiftyeight children clinically diagnosed with HFMD were enrolled Throat swabs， saliva and fecal samples collected from all participants were positive for enterovirus 71 （EV71） orcoxsackievirus A16 （CoxA16） by fluorescent quantitative PCR According to the virus type and disease severity， all patients were divided into mild EV71， severe EV71， mild CoxA16 and severe CoxA16 groups The negative conversion of enterovirus nucleic acids in three types of samples was analyzed among four groups ResultsIn 58 children with HFMD， 38 cases （66%） were positive for EV71 （including 20 mild and 18 severe EV71） and 20 （34%） positive for CoxA16 （including 11 mild and 9 severe CoxA16） The longest time of virus shedding in the fecal samples from EV71infected children was 63 d， and 42 d for those infected with CoxA16 For children with severe EV71 and CoxA16， the time of negative conversion of enterovirus nucleic acids in the fecal samples was significantly longer than that in the throat swabs and saliva samples （both P<005） For children with mild EV71 and CoxA16， the time of negative conversion of enterovirus nucleic acids in the fecal， throat swabs and saliva samples was significantly shorter than that in their counterparts with severe EV71 and CoxA16 （all P<005） ConclusionsThe time of virus shedding is correlated with the disease severity in children with handfootmouth disease The time of virus shedding is prolonged in children with more serious disease Three types of samples should be collected during the early stage of handfootmouth disease， whereas the fecal samples should be emphasized in the advanced stage of the disease

【Key words】Handfootmouth disease； Throat swabs； Saliva； Feccal； Viral nucleic acid；

Negativeconversion time

手足口病是一种由肠道病毒感染所引起的具有传染性的疾病，其主要的病原体包括肠道病毒71型（EV71）和柯萨奇病毒A16型（CoxA16），好发于5岁以下的儿童[12]。重症病例可并发中枢神经系统炎症、心肌炎、神经源性肺水肿等，早期临床症状不典型、病情常突然急转直下，往往在发病早期突然出现预后不良的情况，并因此引发医患矛盾[3]。对手足口病患儿实施隔离可切断手足口病的传染源，是防止手足口病流行的重要措施，而患儿的排泄物中病毒的排毒时间是制定隔离期的重要参考。荧光定量PCR技术是检测手足口病肠道病毒的有效手段[4]。本研究对手足口病患儿不同来源样本的病毒核酸存在时间进行比较，并分析不同病情、不同病原体患儿持续排毒时间的差异，探讨手足口病的传播规律，现报告如下。……