阮燕如 陆少颜

【摘要】 目的：分析廣东省江门市2017-2020年手足口病的流行特征，了解非EV71型非CA16型肠道病毒的分子流行病学特征，为本市进一步临床治疗和防控工作提供科学依据。方法：通过全国传染病报告信息管理系统收集2017-2020年本市手足口病患儿资料，收集整理2017-2020年本院信息系统报告的手足口病例及分析其流行特征，采用荧光RT-PCR法对疑似手足口病患者标本同时进行EV通用型、EV71型、CA16型检测，并选取EV71型和CA16阴性而EV通用型阳性的标本进行型别鉴定，设计5非编码区特异性引物，RT-PCR扩增后进行序列测定，最后对核苷酸的同源性进行比对及确定病毒的型别。结果：2017-2020年江门市共报告HFMD总发病人数为31 709例，其中2017年报告病例数最高。4年内共采集了因怀疑手足口病到本院就诊患儿的2 587例标本，并同时进行EV通用型、EV71型、CA16型检测，总阳性1 263例，总阳性率为48.82%。阳性主要以托幼儿童和男患儿为主。其中EV71核酸阳性173例，占13.70%;CA16核酸阳性282例，占22.33%;其他EV核酸阳性808例，占63.97%。在2017-2020年中确定属于肠道病毒分型共87份，检出的非EV71型非CA16型的肠道病毒有6种型别，分别为CA6、CA10、CA4、CA12、CA5、CA8，其中CA6是占主要的，为70.11%，其次是CA10占13.79%。结论：江门市手足口病的分布呈现出人群差异、季节差异，非EV71型非CA16型的肠道病毒病原谱有六种，病毒型别以CA6为主。应持续进行病原学检测，掌握优势型别，为防控提供依据。

【关键词】 手足口病 流行病学 病原学监测 非EV71非CA16肠道病毒 病原谱

Epidemiological Characteristics of Hand Foot Mouth Disease and Analysis of Non EV71 and Non CA16 Enterovirus Types in Children in Jiangmen/RUAN Yanru， LU Shaoyan. //Medical Innovation of China， 2021， 18（12）： 0-101

[Abstract] Objective： To analyze the epidemiological characteristics of hand foot mouth disease （HFMD） in Jiangmen City， Guangdong Province from 2017 to 2020， and to understand the molecular epidemiological characteristics of non EV71 and non CA16 enterovirus， so as to provide scientific basis for further clinical treatment and prevention and control. Method： Through the national infectious disease reporting information management system to collect the information of HFMD cases in our city from 2017 to 2020， the HFMD cases reported in our hospital from 2017 to 2020 were collected and sorted out and their epidemic characteristics were analyzed. The samples of suspected HFMD patients were detected by fluorescent RT-PCR， and EV71 and CA16 were selected as negative， while EV universal was positive， 5 non coding region specific primers were designed. RT-PCR was used to amplify the 5 non coding region specific primers， and then the sequences were determined. Finally， the nucleotide homology was compared and the virus type was determined. Result： A total of 31 709 HFMD cases were reported in Jiangmen City from 2017 to 2020， among which the highest number was reported in 2017. A total of 2 587 samples of suspected HFMD patients in our hospital were collected in 4 years， and EV universal， EV71， CA16 were detected at the same time， the total positive rate was 48.82% （1 263 cases）. The positive rate was mainly in children and men. Among them， 173 cases were EV71 nucleic acid positive， accounting for 13.70%; 282 cases were CA16 nucleic acid positive， accounting for 22.33%; 808 cases were other EV nucleic acid positive， accounting for 63.97%. A total of 87 enterovirus genotypes were identified in 2017-2020， six types （CA6， CA10， CA4， CA12， CA5， CA8） of enterovirus were detected， including non EV71 and non CA16， among which CA6 was the main， accounting for 70.11%， followed by CA10， accounting for 13.79%. Conclusion： The distribution of HFMD in Jiangmen City shows population and seasonal differences， there are six kinds of enterovirus spectrum of non EV71 and non CA16， and CA6 is the main virus type. The pathogen detection should be carried out continuously to master the dominant types and provide the basis for prevention and control.

[Key words] HFMD Epidemiology Etiology monitoring Non EV71 and non CA16 enterovirus Pathogen spectrum

First-authors address： Jiangmen Maternity and Child Health Care Hospital， Jiangmen 529000， China

doi：10.3969/j.issn.1674-4985.2021.12.023

手足口病（hand，foot and mouth disease，HFMD）是由肠道病毒（EV）感染引起的儿童常见传染病，多发生于5岁以下儿童，临床症状主要为发热和手、足、口腔等部位出现水疱，个别患儿可发生心肌炎、肺水肿、无菌性脑膜炎等致命性疾病[1-2]。……