摘要目的 分析2014年河南省手足口病(HFMD)重症病例病原学特征.方法 整群抽取郑州市某儿童医院2014年4-6月244例HFMD住院病例作为研究对象,采集粪便标本,病原学检测采用荧光定量RT-PCR、病毒分离、VP1测序比对等方法.病原学特征统计分析采用SPSS17.0软件.结果 244例手足口病病例中,重症组109例,轻症组135例,肠道病毒(EV)通用引物RT-PCR阳性229例,阳性率为93.85％.肠道病毒71型(EV71)、柯萨奇病毒A组16型(Cox A16)和CoxA10的感染构成比分别为83.84％、5.68％和8.30％.EV71感染致8例心肺功能衰竭,2例死亡;CoxA10感染致1例心肺功能衰竭、死亡.重症组与轻症组之间肠道病毒感染率差异有统计学意义(x2=5.312,P=0.021).采用Fisher精确概率法对重症组和轻症组EV71、Cox A16和其他EV感染构成比进行统计学比较,P=0.048.EV71和CoxA10感染致心肺功能衰竭发生率和致死率的差异无统计学意义(分别为x2=0.051,P=0.821和x2=2.198,P=0.138).2014年河南省CoxA10分离株属于基因6型,VP1区段核苷酸和氨基酸同源性分别为94.3％ ～ 99.7％和96.3％～100.0％.结论 EV71仍然是河南省HFMD的主要病原.Cox A10在感染病原谱中所占比加大,且感染后可致心肺功能衰竭,应加强对其他EV的监测.

abstractsObjective To investigate the etiology of severe hand-foot-mouth disease (HFMD) in children in Henan province.Methods A total of 244 HFMD cases admitted to a hospital in Zhengzhou from April to June of 2014 were recruited for research sampling,Real-time RT-PCR,virus isolation,VP1 sequencing and alignment methods were used to test the enterovirus-related etiology.SPSS 17.0 was used in performing statistical analysis.Results There were 109 severe and 135 mild cases among all the 244 HFMD cases.The number of enterovirus positive stool samples was 229,with positive rate as 93.85％.EV71,Cox A16 and Cox A10 made up 83.84％,5.68％ and 8.30％ of the enterovirus etiologicy,strains,respectively.EV71 infection caused 8 HFMD cases with heart-lung failure and 2 death,Cox A10 infection led to 1 HFMD case with heart-lung failure and death.There were statistically differences seen regarding the enterovirus infection rotes between severe and the mild HFMD cases (x2=5.312,P=0.021).Statistically significant difference was seen in the constituent ratio of EV71,Cox A16 and the others by Fisher's exact test (P=0.048).There was statistically significant difference seen between the cardiorespiratory failure rate and the fatality rate by EV71 and Cox A10 infection (x2=0.051,P=0.821;x2=2.198,P=0.138).Cox A10 strains idenfied in Henan in 2014 belonged to genotype 6.The rates on homology of nucleotide and amino acid among the Cox A10 strains in Henan in 2014 were 94.3％-99.7％ and 96.3％-100.0％ respectively.Conclusions EV71 still remained the most common pathogen that causing severe HFMD in children,with the increasing Cox A10 percentage in the pathogens spectrum of HFMD infection.Cox A10 strains in Henan in 2014 belonged to genotype 6.Genotype 6 Cox A10 had appeared and widely distributed in Henan for long time,but not yet variated or reconstructed.Cox A10 infection could lead to cardio-respiratory failure thus called for the monitoring program on non-EV71 and non-Cox A16 enterovirus,especially Cox A10 to be strenthened.