广西某地区5岁以下儿童病毒性腹泻的分子流行病学研究

发布时间：2019-05-23 22:35

【摘要】：目的了解2013年广西三江地区5岁以下儿童腹泻病毒的感染情况,明确四种常见腹泻病毒的分子流行病学特征及基因型分布特征,为病毒性腹泻的防治及疫苗的研发提供基础数据。方法1 2013年1月至12月,以人群为基础,通过在广西省三江县农村地区建立主动与被动相结合的腹泻监测系统,对三江县老堡乡和良口乡5岁以下腹泻儿童进行流行病学监测,收集腹泻儿童的粪便标本与临床信息;2采用磁珠法提取病毒RNA/DNA,利用逆转录聚合酶链反应扩增人轮状病毒(Human Rotavirus,HRV)、人杯状病毒(Human Calicivirus,Hu CV)、人星状病毒(Human Astrovirus,HAst V)及小双节RNA病毒(Picobirnaviruses,PBV),聚合酶链反应扩增人肠道腺病毒(Human Enteric Adenovirus,HEAdv),并对凝胶电泳鉴定阳性的标本进行序列测定,确定病毒感染的基因型;3根据实验室检测结果,结合人口学资料,分析该地区5岁以下儿童病毒性腹泻的分子流行病学特征;根据腹泻患儿的临床症状,对腹泻病情的轻重进行评价。结果1基本情况:2013年1月至12月,监测区域5岁以下儿童平均人数3108人,发生腹泻1258人次,腹泻发病率为405/1000(1258/3108)。收集粪便标本1216人次,检出腹泻病毒阳性318份,总检出率26.15%(318/1216)。其中轮状病毒、杯状病毒、肠道腺病毒,星状病毒检出率分别为11.8%(144/1216)、8.06%(98/1216)、6.41%(78/1216)和1.70%(21/1216),小双节RNA病毒未检出。四种腹泻病毒混合感染22例,其中两种病毒混合感染15例,包括Hu CV混合感染HEAdv 10例,Hu CV混合感染HRV 3例,Hu CV混合感染HAst V 2例,HRV和HEAdv混合感染6例;三种病毒混合感染1例,为HRV、Hu CV和HAst V混合感染。2流行病学特征:HRV、Hu CV、HEAdv腹泻基本全年均可发生,发病高峰主要集中在秋冬季,HAst V感染具有明显的季节分布特征,主要分布在冬季12月份,占全部阳性病例的76.19%(16/21)。5岁以下儿童四种病毒性腹泻的发病率分别为HRV 46.33/1000(144/3108)、Hu CV 31.53/1000(98/3108)、HEAdv23.03/1000(78/3108)、HAst V 6.76/1000(21/3108),发病高峰均主要集中在6-23月龄。3临床特征:病毒性腹泻患儿临床症状主要为腹泻、呕吐、发热等。HRV、Hu CV、HEAdv及HAst V感染的腹泻患儿腹泻与呕吐同时发生的人数分别为43例(29.9%,43/144)、19例(19.4%,19/98)、17例(21.8%,17/78)和2例(9.5%,2/21);发烧人数分别为41例(28.50%,41/144)、22例(22.4%,22/98)、26例(33.3%,26/78)和3例(14.3%,3/21);24小时内最大腹泻次数分别为14次、13次、13次和7次;4流行基因型/血清型:A组HRV成功G分型130份,其中G1型49份(34%,49/144),G2型16份(11.1%,16/144),G3型27份(18.8%,27/144),G9型36份(25%,36/144),G2+G9混合型2份(1.4%,2/144),未发现G4型;成功P分型105份,其中P[4]型17份(11.8%,1/144),P[8]型88份(61.1%,88/144),未发现P[6]、P[9]和P[10]型。No V以GII.6型最多见(45%,24/53),其次为GII.4型(43%,23/53),Sa V以GI.1型最多(30%,11/37),其次为GII.1型(22%,8/37);HEAdv以Ad40型(51%,40/78)型为主,其次是Ad5型(20%,16/78),Ad41型(10%,8/78)、Ad1型(9%,7/78);HAst V以As2型最多见(47.62%,10/21),其次为As1型(28.57%,6/21)。结论HRV是三江地区5岁以下儿童病毒性腹泻的最主要病原体,其次是HuCV和HEAdv;引起儿童腹泻的主要基因型为HRV的G1P[8]型、No V的GII.6型及HEAdv的Ad40型;HRV、Hu CV腹泻的流行高峰在秋冬季,HAst V感染主要在冬季,HEAdv感染没有明显的季节分布特征;2岁以下婴幼儿为病毒性腹泻的高危人群;病毒性腹泻患儿临床症状主要为腹泻、呕吐、发热等,轮状病毒是引起重症腹泻的主要病原;
[Abstract]:Objective To study the prevalence of diarrhea virus in children under the age of 5 in the Sanjiang area of Guangxi in 2013, to identify the molecular epidemiological characteristics and the distribution of the four common diarrhoeal diseases, and to provide the basic data for the prevention and treatment of viral diarrhea and the development of the vaccine. Methods From January to December of 2013, based on the population, through the establishment of active and passive diarrhea monitoring system in the rural areas of the Sanjiang county, the epidemiological monitoring was carried out for children under the age of 5 years old in Laoshan and Liangkou of Sanjiang County. The stool samples and clinical information of children with diarrhea were collected. The virus RNA/ DNA was extracted by magnetic bead method. Human Rotavirus (HRV), Human Calicivirus (Hu CV), human astrovirus (Hu CV), human astrovirus (Hu CV), human astrovirus (HAst V) and small double-section RNA virus (Picobirnavies) were amplified by reverse transcription polymerase chain reaction (RT-PCR). PBV (PBV), human intestinal adenovirus (HEAdv) was amplified by polymerase chain reaction (PCR), and the positive samples were determined by gel electrophoresis to determine the genotype of the virus. The molecular epidemiological characteristics of viral diarrhea in children under 5 years of age in the region were analyzed, and the severity of the diarrhea was evaluated according to the clinical symptoms of the children with diarrhea. Results 1 Basic information: From January to December 2013, the average number of children under 5 years of age in the monitoring region was 3108, with 1258 diarrhea, and the incidence of diarrhea was 405/1000 (1258/3108). The total detection rate was 26.15% (318/1216), and the total detection rate was 26.15% (318/1216). The detection rate of rotavirus, cup-type, intestinal adenovirus and star-like virus was 11.8% (144/1216), 8.06% (98/1216), 6.41% (78/1216) and 1.70% (21/1216) respectively. There were 22 cases of mixed infection of four kinds of diarrhea virus, including 15 cases of mixed infection of two kinds of viruses, including Hu CV mixed infection HEAdv 10 cases, Hu CV mixed infection HRV 3 cases, Hu CV mixed infection Hst V 2 cases, HRV and HEAdv mixed infection in 6 cases, and three kinds of virus mixed infection in 1 case, and it was HRV, Hu CV and HAst V mixed infection. The epidemiological characteristics: HRV, Hu CV and HEAdv diarrhea can occur in the whole year. The incidence peak is mainly concentrated in the autumn and winter, and the HAst V infection has obvious seasonal distribution characteristics, mainly distributed in the winter of December, The incidence of four kinds of viral diarrhea was 46.33/1000 (144/3108), Hu CV 31.53/1000 (98/3108), HEA 23.03/1000 (78/3108), Hst V 6.76/1000 (21/3108), and the peak of incidence was mainly concentrated at 6-23 months. The incidence of diarrhea and vomiting was 43 (29.9%,43/144),19 (19.4%,19/98),17 (21.8%,17/78) and 2 (9.5%,2/21), respectively. The number of fever was 41 (28.50%,41/144) and 22 (22.4%), respectively. 22/98),26 (33.3%,26/78) and 3 (14.3%,3/21); the maximum number of diarrhea in 24 hours was 14,13,13 and 7;4 prevailing genotype/ serotype: Group A, HRV, successfully G,130, of which type G1 49 (34%,49/144), type G2 16 (11.1%,16/144), 27 (18.8%,27/144) of G3,36 (25%,36/144) of G9,2 (1.4%,2/144) of G2 + G9,105 in P type,17 (11.8%,1/144) of P[8],88 (61.1%,88/144) of P[6], P[9] and P[10]. No V is at most (45%,24/53), followed by GII.4 (43%,23/53), Sa V is GI. Type 1 (30%,11/37), followed by GII.1 (22%,8/37); HEAdv is dominated by Ad40 (51%,40/78), followed by Ad5 (20%,16/78), Ad41 (10%,8/78), Ad1 (9%,7/78); HAst V at most (47.62%,10/21), followed by As1 (28.57%,6/21). Conclusion HRV is the most important pathogen of viral diarrhea in children under 5 years of age in the Sanjiang area, followed by HuCV and HEAdv. The main genotype of the children's diarrhea is the G1P[8] type of HRV, the GII of No V and the Ad40 of HEAdv, and the epidemic peak of HRV and Hu CV diarrhea is in the autumn and winter. HAst V infection is mainly in winter, and HEAdv infection has no obvious seasonal distribution characteristics; infants under the age of two are at high risk of viral diarrhea; the clinical symptoms of children with viral diarrhea are mainly diarrhea, vomiting, fever and the like, and the rotavirus is the main pathogen causing severe diarrhea;
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.1

【参考文献】