摘要
目的了解宁海县柯萨奇病毒A组6型(Cox A6)所致手足口病伴脱甲症的流行特征,为手足口病病原学监测、诊疗和预防控制提供科学依据。方法对2018-2019年宁海县确诊为Cox A6核酸阳性的手足口病患者病后连续24周随访观察,同时采用反转录聚合酶链式反应(RT-PCR)对手足口病伴脱甲症病例脱落甲碎片标本进行核酸检测和病毒分离。结果感染Cox A6手足口病412例,166例出现不同数量脱甲,脱甲率为40.29%(166/412),平均脱甲6.02个,脱甲时间越早脱甲数越多,按大拇指(趾)-食指-中指-无名指-小指顺序呈依次递减(趋势χ^2=117.39,P<0.001);脱甲时间最短7 d,最长达116 d,70%发生在15~42 d(3~6周);指(趾)甲脱落程度不等,脱甲最多的是大拇指(趾),脱甲右手多于左手,右脚多于左脚,指甲脱落率高于趾甲(χ^2=103.61,P<0.001),四肢指(趾)甲的总体病变率不相同(χ^2=105.40,P<0.001);RT-PCR检测脱落甲碎片Cox A6阳性率为91.67%(11/12),未脱甲及新生甲均为阴性。宁海县流行的手足口病伴脱甲症相关Cox A6 D3基因亚型的D3a.2分支与我国目前主要流行型别一致。结论 Cox A6感染手足口病患者伴脱甲发生率为40%,可能是Cox A6病毒直接对指(趾)甲侵害所致,脱甲可再生。宁海县流行的手足口病伴脱甲症相关Cox A6 D3a.2分支基因亚型与我国目前主要流行型别一致。
Objective To understand the epidemiologic characteristics of coxsachie virus A6(Cox A6)-caused hand foot and mouth disease(HFMD) cases with onychomadesis in Ninghai county of Zhejiang province and provide evidence for the etiologic surveillance, diagnosis/treatment and prevention/control of HFMD. Methods From 1 January 2018 to 31 December 2019, the surveillance data of HFMD cases were collected from hospitals in Ninghai. Follow up was conducted for the patients diagnosed with HFMD caused by Cox A6 for 24 consecutive weeks. The fluorescent reverse transcription-polymerase chain reaction(RT-PCR) was performed for the nucleic acid detection of enterovirus strains isolated. The full length of VP1 amplification, sequencing and phylogenetic analysis of Cox A6 strains were conducted. Results A total of 412 patients with HFMD caused by Cox A6 were surveyed, in which 166 had different degrees of nail shedding, the incidence rate of onychomadesis was 40.29%(166/412), the average number of shed nails was 6.02, the earlier onychomadesis occurred, the more nails shed. The incidence rate was highest in thumbs(toes), followed by index fingers, middle fingers, ring fingers and little fingers( trend χ^2=117.39,P<0.001);The shortest onset time of onychomadesis was on day 7 and the longest was on day 116 after HFMD occurred. About 70% cases developed onychomadesis between day 15 and day 42(3–6 week) after HFMD occurred. The degree of nail loss varied, and thumbs(toes)were mostly affected, Fingernail shedding mainly occurred in right hands and toenail shedding mainly occurred in right foots.The incidence rate of onychomadesis was higher in fingernails than in toenails( χ^2=103.61, P<0.001), the overall incidence of onychomadesis varied among four limbs(χ^2=105.40,P<0.001). Cox A6 positive rate was 91.67%(11/12) in shed nail samples by RT-PCR, but unshed and new nail samples were negative for Cox A6. The gene subtype of D3 a.2 clade of the Cox A6 strains isolated from HFMD cases in Ninghai was consistent with the main circulating gene subtype in China. Conclusion The incidence rate of onychomadesis in Cox A6-caused HFMD cases was 40%, the possible reason might be the direct invasion of Cox A6 virus to nail, but nail can regenerate. The gene subtypes of D3 a.2 clad of the Cox A6 strains isolated from HFMD cases with onychomadesis in Ninghai was consistent with the main circulating gene subtype in China.
作者
秦海燕
孔志芳
倪红霞
王晓英
杨斌
张丹
鲁琴宝
Qin Haiyan;Kong Zhifang;Ni Hongxia;Wang Xiaoying;Yang Bin;Zhang Dan;Lu Qinbao(Ninghai County First Hospital,Ninghai 315600,Zhejiang,China;Ninghai County Center for Disease Control and Prevention,Ninghai 315600,Zhejiang,China;Ningbo Prefectural Center for Disease Control and Prevention,Ningbo 315010,Zhejiang,China;Zhejiang Provincial Center for Disease Control and Prevention,Hangzhou 310051,Zhejiang,China)
出处
《疾病监测》
CAS
2020年第11期1014-1019,共6页
Disease Surveillance
关键词
柯萨奇病毒A组6型
手足口病
脱甲症
核酸检测
Coxsachie virus A6
Hand
foot and mouth disease
Onychomadesis
Nucleic acid detection
作者简介
同为第一作者:秦海燕,女,浙江省宁海县人,副主任医师,本科,主要从事传染病防制工作,Email:qhyznh@126.com,ORCID:0000−0002−4320−376X;同为第一作者:孔志芳,女,浙江省宁海县人,主任医师,本科,主要从事急性传染病防制工作,ORCID:0000−0001−8914−1894;通信作者:孔志芳,Tel:0574-65577158,Email:774162991@qq.com。
