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目的:分析手足口病病原谱变迁和标本类型及采样时间对病原学诊断的意义。方法:自2008年5月-2010年5月连续采集临床诊断为手足口病病例的咽拭子、肛拭子、大便、疱疹液和脑脊液进行EV71、CoxA16等肠道病毒核酸检测。结果:EV71,CoxA16和其他肠道病毒核酸检出率分别为:2008年26.0%,5.2%,9.4%;2009年47.9%,21.4%,4.3%;2010年25.0%,38.6%,6.8%。咽拭子、疱疹液、肛拭子或大便、脑脊液标本检出率分别为65.5%、59.7%、71.4%、0%;咽拭子标本与肛拭子或大便标本检测结果符合率为87.0%,与疱疹液符合率为75.0%;病后当天、病后1~3天、病后4~7天采集的标本检出率分别为83.8%、58.0%、59.7%。结论:2008年5月-2010年5月引起手足口病的主要病原是EV71和CoxA16,但每年病原谱在不断变化;引起手足口病重症病例的主要病原为EV71,未见CoxA16。在病后7天内采集病人咽拭子或肛拭子或大便或疱疹液标本对手足口病的病原诊断无显著差异。
OBJECTIVE: To analyze the pathogenic changes of hand-foot-mouth disease and the significance of specimen types and sampling time in the etiological diagnosis. Methods: Throat swab, anal swab, stool, herpes fluid and cerebrospinal fluid were collected from May 2008 to May 2010 for EV71 and CoxA16. Results: The detection rates of EV71, CoxA16 and other enterovirus nucleic acids were 26.0%, 5.2%, 9.4% respectively in 2008, 47.9%, 21.4%, 4.3% in 2009 and 25.0%, 38.6%, 6.8% in 2010. The detection rate of throat swab, herpes fluid, anal swab or stool and cerebrospinal fluid were 65.5%, 59.7%, 71.4% and 0% respectively. The coincidence rate of throat swab specimens with anal swab or stool specimens was 87.0% The coincidence rate with herpes fluid was 75.0%. The detection rate of specimens collected from the day after illness, 1 to 3 days after illness and 4 to 7 days after illness were 83.8%, 58.0% and 59.7% respectively. Conclusion: The main pathogen of HFMD caused by HFMD is EV71 and CoxA16 from May 2008 to May 2010, but the pathogen spectrum changes constantly every year. The main pathogen causing HFMD is EV71, but no CoxA16. There was no significant difference in pathogen diagnosis of hand-foot-mouth disease among the patients who took throat swabs or anal swabs or stool or herpes fluid samples within 7 days after illness.