2020—2021年芜湖市某三甲医院手足口病流行病学特征及病原学检测结果分析

方续兰; 汪丙松; 李振; 兰挺

doi:10.16766/j.cnki.issn.1674-4152.002507

2020—2021年芜湖市某三甲医院手足口病流行病学特征及病原学检测结果分析

doi: 10.16766/j.cnki.issn.1674-4152.002507

芜湖市第一人民医院儿童医学中心，安徽芜湖 241000

基金项目:

安徽省卫生健康委科研项目 AHWJ2021b084

详细信息

通讯作者:
汪丙松, E-mail: Wuhuwbs@163.com

中图分类号: R512.5 R183.1
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- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2021-12-01
- 网络出版日期: 2022-09-21

Analysis of the epidemiological characteristics and pathogenic detection results of hand, foot and mouth disease in a tertiary hospital in Wuhu City from 2020 to 2021

Department of Pediatrics, the First People ' s Hospital of Wuhu, Wuhu, Anhui 241000, China

摘要

摘要: 目的分析2020-2021年芜湖市某三甲医院手足口病流行病学和病原学特征, 为本市制定手足口病防控策略提供参考依据。方法对2020年1月-2021年12月芜湖市第一人民医院的200例手足口病样本进行流行病学分析, 利用实时荧光定量PCR法进行病原学检测。结果 200例手足口病病例中, 男女性别比为1.9:1;3岁以下散居患儿占比最高(81.0%), 为该疾病的高发人群。2020-2021年手足口病病原体以柯萨奇病毒A16型(CoxA16)和肠道病毒71型(EV71)为主, 其例数和占比分别为96例(48.0%)和90例(45.0%), 呈现共同流行态势。从标本检出率方面看, 咽拭子检出率最高(38.5%), 疱疹液检出率最低(29.0%), 但不同标本病毒检出率差异无统计学意义(P>0.05)。200例患儿中, 133例为普通型(66.5%), 67例重症型(33.5%)。与普通组比较, 重症患儿体温>39℃、心律失常、急躁、肢体抖动、颈项强直等症状的发生率明显增加(均P < 0.05)。结论手足口病在不同人群、时间、地区上的分布具有一定差异性。CoxA16和EV71型肠道病毒型已成为本辖区手足口病的优势病毒型别。应进一步加强手足口病病原学监测, 同时要进行相关知识的宣教, 提高医师对病例表现的识别能力。
- 手足口病 /
- 流行病学 /
- 特征 /
- 病原学 /
- 监测
Abstract: Objective To analyse the epidemiological and pathogenic characteristics of hand, foot and mouth disease in a tertiary hospital in Wuhu City from 2020 to 2021 and to provide a reference for the city to formulate prevention and control strategies for hand, foot and mouth disease. Methods Epidemiological analysis was performed on 200 samples of hand, foot and mouth disease, and pathogenic detection was performed by real-time fluorescent quantitative PCR. Results In 200 cases of hand, foot and mouth disease, the male-to-female ratio was 1.9:1.Scattered children under 3 years of age accounted for the highest proportion of the total number of people, and 81.0% were at high risk of contracting the disease.From 2020 to 2021, the pathogens of hand, foot and mouth disease in this city were mainly CoxA16(96 cases, 48.0%) and EV71(90 cases, 45.0%), showing a common epidemic situation.In terms of detection rate, throat swabs were the highest (38.5%), and herpes fluid was the lowest (29.0%).However, the detection rates of various viruses were relatively close (P>0.05).Among the 200 cases, 133 cases were normal type (66.5%) and 67 cases were severe syndrome type (33.5%).Compared with the normal type, the incidence of symptoms such as body temperature>39℃, arrhythmia, impatience, limb shaking and neck stiffness in severe group were significantly increased (all P < 0.05). Conclusion The distribution of hand, foot and mouth disease has certain differences in different populations, times and regions.CoxA16 and EV71 enterovirus types have become the dominant virus types of hand, foot and mouth disease.Therefore, it is necessary to further strengthen its pathogenic monitoring, and at the same time conduct related knowledge education to improve the doctor's ability to identify case manifestations.
- Hand, foot and mouth disease /
- Epidemiology /
- Features /
- Aetiology /
- Surveillance

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表 1 手足口病患儿人群分布特征

Table 1. Distribution characteristics of children with HFMD

项目	类别	例数	构成比(%)
性别	男	131	65.5
	女	69	34.5
年龄(岁)	≤1	9	4.5
	＞1~2	85	42.5
	＞2~3	68	34.0
	＞3~4	11	5.5
	＞4~5	10	5.0
	＞5~6	17	8.5

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表 2 2020—2021年芜湖市某三甲医院手足口病病原学检测结果[例(%)]

Table 2. Etiological detection results of hand, foot and mouth disease in a tertiary hospital in Whhu City from 2020 to 2021[cases(%)]

年份	例数	EV71	CoxA16	CoxA6	CoxA10
2020	66	34(51.5)	30(45.5)	1(1.5)	1(1.5)
2021	134	56(41.8)	66(49.2)	6(4.5)	6(4.5)
合计	200	90(45.0)	96(48.0)	7(3.5)	7(3.5)

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表 3 手足口病患儿不同类型标本检测结果

Table 3. Results of different types of specimens in children with HFMD

标本类型	标本数量	构成比(%)	EV71(例)	CoxA16(例)	其他(例)
咽拭子	77	38.5	39	33	5
肛拭子	65	32.5	32	26	7
疱疹液	58	29.0	19	37	2
合计	200	100.0	90	96	14

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表 4 2组手足口病患儿临床特征比较(例)

Table 4. Comparison of clinical characteristics between two groups of children with hand, foot and mouth disease (cases)

组别	例数	体温＞39 ℃	心率加快	心律失常	四肢发凉	抽搐	急躁	肢体抖动	呕吐	肌肉痛楚	颈项强直
重症组	67	12	8	7	5	3	6	2	3	2	2
普通组	133	80	12	1	2	1	1	0	19	17	0
χ²值		31.843	0.419	8.529	3.086	1.541	6.615	4.010	4.356	4.949	4.010
P值		＜0.001	0.517	0.004	0.079	0.215	0.010	0.045	0.037	0.026	0.045

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参考文献(22)

[1]	中华人民共和国国家卫生健康委员会. 手足口病诊疗指南(2018年版)[J]. 中华临床感染病杂志, 2018, 11(3): 161-166. doi: 10.3760/cma.j.issn.1674-2397.2018.03.001 National Health Commission of the People ' s Republic of China. Guidelines for diagnosis and treatment of hand, foot and mouth disease (2018 edition)[J]. Chinese Journal of Clinical Infectious Diseases, 2018, 11(3): 161-166. doi: 10.3760/cma.j.issn.1674-2397.2018.03.001
[2]	包丽娟, 许富民, 梁兴业. 国内手足口病流行病学特征及疫苗研究进展[J]. 微生物学免疫学进展, 2020, 48(6): 82-86. https://www.cnki.com.cn/Article/CJFDTOTAL-WSMY202006023.htm BAO L J, XU F M, LIANG X Y. Epidemiological characteristics and vaccine research progress of hand, foot and mouth disease in China[J]. Progress in Microbiology and Immunology, 2020, 48(6): 82-86. https://www.cnki.com.cn/Article/CJFDTOTAL-WSMY202006023.htm
[3]	CHAN J H, LAW C K, HAMBLION E, et al. Best practices to prevent transmission and control outbreaks of hand, foot, and mouth disease in childcare facilities: A systematic review[J]. Hong Kong Med J, 2017, 23(2): 177-190.
[4]	UPALA P, APIDECHKUL T, SUTTANA W, et al. Molecular epidemiology and clinical features of hand, foot and mouth disease in northern Thailand in 2016: A prospective cohort study[J]. BMC Infect Dis, 2018, 18(1): 630. doi: 10.1186/s12879-018-3560-4
[5]	JI H, FAN H, LU P X, et al. Surveillance for severe hand, foot, and mouth disease from 2009 to 2015 in Jiangsu province: Epidemiology, etiology, and disease burden[J]. BMC Infect Dis, 2019, 19(1): 79. doi: 10.1186/s12879-018-3659-7
[6]	QIU J, YAN H, CHENG N, et al. The clinical and epidemiological study of children with hand, foot, and mouth disease in Hunan, China from 2013 to 2017[J]. Sci Rep, 2019, 9(1): 11662. doi: 10.1038/s41598-019-48259-1
[7]	初阳. 天津市某地区手足口病流行病学特征及影响因素研究[D]. 天津: 天津医科大学, 2018. CHU Y. Epidemiological characteristics and influencing factors of hand, foot and mouth disease in a region of Tianjin[D]. Tianjin: Tianjin Medical University, 2018.
[8]	张龙, 冀慧方, 高雷. 上海市嘉定区2011—2018年手足口病流行病学分析[J]. 上海医药, 2019, 40(20): 54-56. doi: 10.3969/j.issn.1006-1533.2019.20.018 ZHANG L, JI H F, GAO L. Epidemiological analysis of hand, foot and mouth disease in Jiading District of Shanghai from 2011 to 2018[J]. Shanghai Medical and Pharmaceutical Journal, 2019, 40(20): 54-56. doi: 10.3969/j.issn.1006-1533.2019.20.018
[9]	张珺茹, 蔡源益, 王爱, 等. 2014年至2016年全国手足口病发病季节高峰的圆形分布分析[J]. 中国医科大学学报, 2017, 46(6): 524-526, 531. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK201706010.htm ZHANG J R, CAI Y Y, Wang A, et al. Circular distribution analysis of seasonal peak of hand, foot and mouth disease in China from 2014 to 2016 [J]. Journal of China Medical University, 2017, 46(6): 524-526, 531. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK201706010.htm
[10]	韩裕乐, 王梅君. 上海市浦东新区手足口病发病特征与气象因素的关联[J]. 上海预防医学, 2018, 30(1): 55-58. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI201801018.htm HAN Y L, WANG M J. Association between incidence characteristics of hand, foot and mouth disease and meteorological factors in Pudong New Area of Shanghai[J]. Shanghai Journal of Preventive Medicine, 2018, 30(1): 55-58. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI201801018.htm
[11]	齐特, 黄郁晶, 吉耀华, 等. 2014—2018年沈阳地区手足口病病原分布及流行特征[J]. 中国感染控制杂志, 2020, 19(7): 648-652. QI T, HUANG Y J, JI Y H, et al. Etiological distribution and epidemiological characteristics of hand, foot and mouth disease (HFMD) in Shenyang from 2014 to 2018[J]. Chinese Journal of Infection Control, 2020, 19(7): 648-652.
[12]	吉连福, 杨恩辉, 单鸣凤, 等. EV71型病毒疫苗接种后住院患儿手足口病流行病学特征及病原学变化[J]. 中国感染控制杂志, 2020, 19(6): 546-552. https://www.cnki.com.cn/Article/CJFDTOTAL-GRKZ202006012.htm JI L F, YANG E H, SHAN M F, et al. Epidemiological characteristics and etiological changes of hand, foot and mouth disease in hospitalized children after EV71 virus vaccination[J]. Chinese Journal of Infection Control, 2020, 19(6): 546-552. https://www.cnki.com.cn/Article/CJFDTOTAL-GRKZ202006012.htm
[13]	张如玉. 郑州市儿童手足口病流行特征及危险因素分析[J]. 深圳中西医结合杂志, 2019, 29(20): 20-22. https://www.cnki.com.cn/Article/CJFDTOTAL-SZZX201920009.htm ZHANG R Y. Epidemiological characteristics and risk factors of hand, foot and mouth disease in children in Zhengzhou[J]. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine, 2019, 29(20): 20-22. https://www.cnki.com.cn/Article/CJFDTOTAL-SZZX201920009.htm
[14]	任祥欣, 韩雅琳, 贾静. 青岛市2013—2017年手足口病重症病例流行特征及临床特点分析[J]. 中国公共卫生管理, 2019, 35(5): 607-609, 616. https://www.cnki.com.cn/Article/CJFDTOTAL-GGWS201905009.htm REN X X, HAN Y L, JIA J. Epidemiological and clinical characteristics of severe hand-foot-mouth disease cases in Qingdao from 2013 to 2017[J]. Chinese Journal of Public Health Management, 2019, 35(5): 607-609, 616. https://www.cnki.com.cn/Article/CJFDTOTAL-GGWS201905009.htm
[15]	李媛, 张振, 路滟, 等. 2005—2017年深圳市手足口病聚集性疫情流行特征及病原学分析[J]. 热带医学杂志, 2019, 19(5): 660-663. doi: 10.3969/j.issn.1672-3619.2019.05.032 LI Y, ZHANG Z, LU Y, et al. Epidemiological characteristics and etiological analysis of a cluster of HFMD outbreaks in Shenzhen from 2005 to 2017[J]. Journal of Tropical Medicine, 2019, 19(5): 660-663. doi: 10.3969/j.issn.1672-3619.2019.05.032
[16]	李鹏宾, 黄嘉殷, 罗国涵, 等. 2010—2017年佛山市南海区手足口病流行特征及时空聚集性分析[J]. 现代预防医学, 2018, 45(24): 4491-4495. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201824019.htm LI P B, HUANG J Y, LUO G H, et al. Epidemiological characteristics and spatial-temporal clustering of hand, foot and mouth disease (HFMD) in Nanhai District, Foshan City from 2010 to 2017[J]. Modern Preventive Medicine, 2018, 45(24): 4491-4495. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201824019.htm
[17]	于宏杰, 倪胜男, 钟培松. 上海市嘉定区2007—2016年手足口病流行特征及病原学分析[J]. 上海预防医学, 2018, 30(12): 1005-1008. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI201812010.htm YU H J, NI S N, ZHONG P S. Epidemiological characteristics and etiological analysis of hand, foot and mouth disease (HFMD) in Jiading District, Shanghai, 2007-2016[J]. Shanghai Journal of Preventive Medicine, 2018, 30(12): 1005-1008. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYI201812010.htm
[18]	王瑾, 彭万胜, 周瑞, 等. 重症手足口病患儿危险因素分析[J]. 中华全科医学, 2021, 19(1): 20-23. doi: 10.16766/j.cnki.issn.1674-4152.001719 WANG J, PENG W S, ZHOU R, et al. Analysis of risk factors for severe hand-foot-mouth disease in children[J]. Chinese Journal of General Practice, 2021, 19(1): 20-23. doi: 10.16766/j.cnki.issn.1674-4152.001719
[19]	李成娟, 赵翠红, 赵利, 等. Logistic回归联合ROC曲线对重症手足口病危险因素的预测价值[J]. 现代医学, 2017, 45(10): 1465-1467. https://www.cnki.com.cn/Article/CJFDTOTAL-TDYX201710019.htm LI C J, ZHAO C H, ZHAO L, et al. Predictive value of Logistic regression combined with ROC curve for risk factors of severe hand, foot and mouth disease [J]. Modern Medical Journal, 2017, 45(10): 1465-1467. https://www.cnki.com.cn/Article/CJFDTOTAL-TDYX201710019.htm
[20]	李娟娟, 苏明, 王玉肖. 不同标本及其组合在手足口病诊断中的意义[J]. 实用预防医学, 2014, 21(1): 97-99. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYY201401037.htm LI J J, SU M, WANG Y X. Different specimens and their combinations in the diagnosis of hand, foot and mouth disease[J]. Practical Preventive Medicine, 2014, 21(1): 97-99. https://www.cnki.com.cn/Article/CJFDTOTAL-SYYY201401037.htm
[21]	马晓梅, 徐学琴, 闫国立, 等. BP神经网络和决策树分析在重症手足口病临床早期预警指标中的应用[J]. 中国卫生统计, 2019, 36(3): 381-383. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT201903016.htm MA X M, XU X Q, YAN G L, et al. Application of BP neural network and decision tree analysis in clinical early warning indicators of severe hand, foot and mouth disease[J]. Chinese Journal of Health Statistics, 2019, 36(3): 381-383. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT201903016.htm
[22]	瞿色华, 周瑞. 重组人干扰素α2b治疗重型早期手足口病疗效观察[J]. 中华全科医学, 2017, 15(12): 2053-2055. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.014 QU S H, ZHOU R. Efficacy of recombinant human interferon α2b in treatment of severe early hand-foot-mouth disease[J]. Chinese Journal of General Practice, 2017, 15(12): 2053-2055. doi: 10.16766/j.cnki.issn.1674-4152.2017.12.014