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499例手足口病患者病原学及柯萨奇病毒A6、A10、A12感染患者临床特征分析
梁金秋
2014-05-13
导师成军
专业内科学
授予单位北京大学
授予地点北京地坛医院教学医院
学位硕士
关键词手足口病 肠道病毒 柯萨奇病毒 A10 柯萨奇病毒 A12 柯萨奇病毒 A6
其他题名Etiology of 499 hand, foot and mouth disease cases and clinical features of coxsackievirus A6, A10 and A12
分类号R725.1
摘要目的 了解2011~2012年北京大学北京地坛医院手足口病住院患者的病原学情况,及柯萨奇病毒A组6、10、12型(CVA6、CVA10、CVA12)的临床特征的差异,为手足口病的预防、诊断、治疗提供更多的依据。方法 1)EV通用型及EV71、CVA16型检测:采集HFMD患儿入院后第1、2、3、5、7 d的咽拭子标本,使用肠道病毒通用型、EV71型和CVA16型核酸检测试剂盒,运用real-time PCR方法对肠道病毒进行鉴定及EV71、CVA16的分型鉴定;非EV71非CVA16的EV型别鉴定:选取EV检测时real-time PCR扩增曲线的Ct值较低的EV检测阳性患者的咽拭子标本,使用PCR扩增肠道病毒的部分VP1片段,并对其进行测序和比对鉴定,得出病毒型别;2)选取59例2010年5月至2012年12月期间北京大学北京地坛医院儿科手足口病住院患者经实验室分型检测为CVA6、CVA10、CVA12感染者,回顾性分析患者的性别、年龄、发病时间、地区分布、住院天数 、临床表现等,根据CVA6、CVA10、CVA12三种不同肠道病毒型别将患者分为三组,分别从性别、年龄、发病时间、地区分布、住院天数 、临床表现方面进行比较。结果 1)本研究对2011年2月至2012年12月间在北京大学北京地坛医院儿科住院的499例手足口病患者进行了肠道病毒的检测的分型鉴定。发现:①肠道病毒阳性患者占53.71%,其中EV71阳性率占23.05%,CVA16阳性率占10.42%,非EV71非CVA16型肠道病毒占20.24%;②非EV71非CVA16肠道病毒中,CVA6、CVA10和CVA12例数较多,分别为11例、10例和9例,剩下的分别为3例CVA4、2例CVA5;③本研究中所有CVA10株和2009年山东、2010年云南和江苏的病毒株遗传距离较近;全部CVA6病毒株分成遗传距离较远的两群; CVA12病毒株与2008至2012年北京、长沙、深圳、江苏等地区的CVA12病毒株亲缘关系较近。 2)本研究入组了2010年5月至2012年12月期间北京大学北京地坛医院儿科59例经实验室分型检测为CVA6、CVA10、CVA12的手足口病住院患者,发现:①CVA10重症患者比例最高;②CVA10阳性病例的血糖升高、乳酸脱氢酶升高、白细胞升高和≥39℃患者百分比高于CVA12和CVA6阳性病例,其中后三者具有统计学差别;③CVA10阳性病例合并脑炎比例显著低于EV71,高于CVA16。 结论 1)EV71仍为手足口病的主要病原体,非EV71非CVA16型肠道病毒阳性率仅次于EV71;非EV71非CVA16型肠道病毒中CVA6、CVA10和CVA12最常见;本研究中2010至2012年的CVA10和CVA12病毒株和国内近几年的病毒株亲缘关系较近,本研究中所有CVA6病毒株分为亲缘关系较远的两群;2)CVA10危险程度低于EV71,高于CVA12、CVA6和CVA16;高热、高白细胞水平、高血糖、血清乳酸脱氢酶水平升高可能是手足口病重症的高危因素。
英文摘要Objectives To understand hand, foot and mouth disease etiology in Division of Pediatrics, Beijing Ditan Hospital, Peking University, in 2011-2012, and analyze clinical features of coxsackievirus A6, A10 and A12 positive HFMD patients. Methods 1) EV universal type, EV71 and CVA16 detection by real-time fluorescence quantitative RT-PCR kits. Typing of non-EV71 and non-CVA16 enteroviruses by VP1 PCR and sequencing and identification. 2) 59 HFMD cases in three groups of CVA6, CVA10 and CVA12 were analysed and compared in fields of age, sex, regional distribution, hospital stay and clinical features. Results 1) 499 HFMD patients hospitalized in the department of Pediatrics of Beijing Ditan Hospital were detected and typed in the study. ①The enterovirus-positive rate was 53.71%. The positive rate of EV71, CVA16 and non-EV71 and non-CVA16 enteroviruses was 23.05%, 10.42% and 20.24% seperately. ② 101 cases of non-EV71 and non-CVA16 enteroviruses were typed into five types, including CVA6 (11, 10.89%), CVA10 (10, 9.9%), CVA12 (9, 8.91%), CVA4 (3, 2.97%) and CVA5 (2, 1.98% ), with 67 cases untyped . ③ CVA10 strains of Bejing from 2010 to 2012 may own the same derive with strains of Jiansu, Shandong and Yunnan, in 2010. Several CVA6 strains of our study in 2012 may have different origins. CVA12 strains of Bejing from 2008 to 2012 may own the same origin. 2) 59 HFMD cases typed CVA6, CVA10 and CVA12 were selected. ① CVA10 group owned higher percentage of severe HFMD cases than CVA6 and CVA12. ② The percentage of CVA10 positive patients with higher blood glucose level, higher blood LDH level, higher WBC level, and a fever higher than 39 degrees were higher than CVA12 or CVA6 groups, with the latter three siganificantly different. ③The percentage of encephalitis in CVA10 patients was significantly less than EV71, greater than CVA16. Conclusions 1) EV71 was still the main pathogen, non-EV71 and non-CVA16 enteroviruses the second, among which CVA6, CVA10 and CVA12 were most common. CVA10 or CVA12 strains in our study had high similarity, while CVA6 strains owned high variability. 2) CVA10 group owned higher percentage of severe HFMD cases than CVA6 and CVA12. Percentage of patients with higher LDH, white blood cells level and abnormal blood glucose level and with a fever over 39℃ among CVA6, CVA10 and CVA12 were signicantly different. These may be high risk factors for severe HFMD cases.The result that CVA10 had the second disease severity after EV71 should cause enough attention.
语种中文
出处http://xuewei.bjmu.edu.cn/simpsearch.action?keyword=499例手足口病患者病原学及柯萨奇病毒A6、A10、A12感染患者临床特征分析&dbid=72
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条目标识符http://ir.bjmu.edu.cn/handle/400002259/105803
专题北京地坛医院教学医院
作者单位北京地坛医院教学医院
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梁金秋. 499例手足口病患者病原学及柯萨奇病毒A6、A10、A12感染患者临床特征分析[D]. 北京地坛医院教学医院. 北京大学,2014.
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