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[目的]探讨2009—2011年上海市宝山区手足口病病原学特征及诊断意义。[方法]2009年3月—2011年12月连续采集手足口病临床诊断病例的咽拭子、大便样本或肛拭子和疱疹液进行肠道病毒71型(enterovirus 71,EV71)、柯萨奇病毒A组16型(coxsackievirus A16,CoxA16)和其他肠道病毒核酸检测。[结果]2009—2011年肠道病毒的总检出率分别为59.00%、72.44%和79.00%,重症(死亡)病例中EV71型肠道病毒的阳性检出率为90.91%,明显高于普通病例(χ2=45.97,P<0.001)和聚集性病例的检出率(χ2=56.85,P<0.001);咽拭子、肛拭子或大便样本、疱疹液、咽漱液标本肠道病毒阳性检出率分别为68.02%、86.67%、71.43%、25.00%;咽拭子标本与肛拭子或大便标本和疱疹液标本检测结果符合率为83.53%和100.00%;发病0~4d肠道病毒核酸检出率为79.73%,5~10d肠道病毒核酸检出率为45.61%,差异有统计学意义(χ2=30.91,P<0.001)。[结论]2009—2011年宝山区手足口病感染的主要病原是EV71型和CoxA16型肠道病毒,肠道病毒的检出率逐年提升,且每年的优势型别有所不同;手足口病重症(死亡)病例的主要病原为EV71型肠道病毒;咽拭子、肛拭子或大便样本、疱疹液都有较高的诊断价值;病后4d内采集标本对手足口病诊断效果较好。
[Objective] To explore the etiological features and diagnostic significance of hand-foot-mouth disease in Baoshan District of Shanghai during 2009-2011. [Methods] From March 2009 to December 2011, throat swabs, stool samples or anal swabs and herpes fluid from clinical diagnosis of HFMD were collected continuously for enterovirus 71 (EV71), Coxsackie Detection of coxsackievirus A16 (CoxA16) and other enterovirus nucleic acids. [Results] The total positive rates of enterovirus in 2009-2011 were 59.00%, 72.44% and 79.00%, respectively. The positive rate of EV71 in severe (death) cases was 90.91%, which was significantly higher than that of common (Χ2 = 45.97, P <0.001), and the detection rate of clustered cases (χ2 = 56.85, P <0.001). The positive rate of enterovirus in throat swabs, anal swabs or stool samples, The detection rates were 68.02%, 86.67%, 71.43% and 25.00% respectively. The coincidence rates of throat swab specimens and anal swabs or stool specimens and herpes fluid specimens were 83.53% and 100.00%, respectively. The incidence of 0 ~ 4d enterovirus The detection rate of nucleic acid was 79.73%, and the detection rate of enterovirus nucleic acid in 5 ~ 10 days was 45.61%. The difference was statistically significant (χ2 = 30.91, P <0.001). [Conclusion] The main pathogens of HFMD infection in Baoshan District in 2009-2011 are EV71 and CoxA16 enterovirus, the detection rate of enterovirus is increasing year by year, and the predominant type is different every year. Hand, foot and mouth disease is severe (Death) cases of the main pathogen EV71 enterovirus; throat swab, anal swab or stool samples, herpes fluid has a higher diagnostic value; within 4d after the acquisition of specimens of foot and mouth disease diagnosis is better.