【摘要】：目的了解2013年廣西三江地區(qū)5歲以下兒童腹瀉病毒的感染情況,明確四種常見(jiàn)腹瀉病毒的分子流行病學(xué)特征及基因型分布特征,為病毒性腹瀉的防治及疫苗的研發(fā)提供基礎(chǔ)數(shù)據(jù)。方法1 2013年1月至12月,以人群為基礎(chǔ),通過(guò)在廣西省三江縣農(nóng)村地區(qū)建立主動(dòng)與被動(dòng)相結(jié)合的腹瀉監(jiān)測(cè)系統(tǒng),對(duì)三江縣老堡鄉(xiāng)和良口鄉(xiāng)5歲以下腹瀉兒童進(jìn)行流行病學(xué)監(jiān)測(cè),收集腹瀉兒童的糞便標(biāo)本與臨床信息;2采用磁珠法提取病毒RNA/DNA,利用逆轉(zhuǎn)錄聚合酶鏈反應(yīng)擴(kuò)增人輪狀病毒(Human Rotavirus,HRV)、人杯狀病毒(Human Calicivirus,Hu CV)、人星狀病毒(Human Astrovirus,HAst V)及小雙節(jié)RNA病毒(Picobirnaviruses,PBV),聚合酶鏈反應(yīng)擴(kuò)增人腸道腺病毒(Human Enteric Adenovirus,HEAdv),并對(duì)凝膠電泳鑒定陽(yáng)性的標(biāo)本進(jìn)行序列測(cè)定,確定病毒感染的基因型;3根據(jù)實(shí)驗(yàn)室檢測(cè)結(jié)果,結(jié)合人口學(xué)資料,分析該地區(qū)5歲以下兒童病毒性腹瀉的分子流行病學(xué)特征;根據(jù)腹瀉患兒的臨床癥狀,對(duì)腹瀉病情的輕重進(jìn)行評(píng)價(jià)。結(jié)果1基本情況:2013年1月至12月,監(jiān)測(cè)區(qū)域5歲以下兒童平均人數(shù)3108人,發(fā)生腹瀉1258人次,腹瀉發(fā)病率為405/1000(1258/3108)。收集糞便標(biāo)本1216人次,檢出腹瀉病毒陽(yáng)性318份,總檢出率26.15%(318/1216)。其中輪狀病毒、杯狀病毒、腸道腺病毒,星狀病毒檢出率分別為11.8%(144/1216)、8.06%(98/1216)、6.41%(78/1216)和1.70%(21/1216),小雙節(jié)RNA病毒未檢出。四種腹瀉病毒混合感染22例,其中兩種病毒混合感染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;三種病毒混合感染1例,為HRV、Hu CV和HAst V混合感染。2流行病學(xué)特征:HRV、Hu CV、HEAdv腹瀉基本全年均可發(fā)生,發(fā)病高峰主要集中在秋冬季,HAst V感染具有明顯的季節(jié)分布特征,主要分布在冬季12月份,占全部陽(yáng)性病例的76.19%(16/21)。5歲以下兒童四種病毒性腹瀉的發(fā)病率分別為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),發(fā)病高峰均主要集中在6-23月齡。3臨床特征:病毒性腹瀉患兒臨床癥狀主要為腹瀉、嘔吐、發(fā)熱等。HRV、Hu CV、HEAdv及HAst V感染的腹瀉患兒腹瀉與嘔吐同時(shí)發(fā)生的人數(shù)分別為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);發(fā)燒人數(shù)分別為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小時(shí)內(nèi)最大腹瀉次數(shù)分別為14次、13次、13次和7次;4流行基因型/血清型:A組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),未發(fā)現(xiàn)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),未發(fā)現(xiàn)P[6]、P[9]和P[10]型。No V以GII.6型最多見(jiàn)(45%,24/53),其次為GII.4型(43%,23/53),Sa V以GI.1型最多(30%,11/37),其次為GII.1型(22%,8/37);HEAdv以Ad40型(51%,40/78)型為主,其次是Ad5型(20%,16/78),Ad41型(10%,8/78)、Ad1型(9%,7/78);HAst V以As2型最多見(jiàn)(47.62%,10/21),其次為As1型(28.57%,6/21)。結(jié)論HRV是三江地區(qū)5歲以下兒童病毒性腹瀉的最主要病原體,其次是HuCV和HEAdv;引起兒童腹瀉的主要基因型為HRV的G1P[8]型、No V的GII.6型及HEAdv的Ad40型;HRV、Hu CV腹瀉的流行高峰在秋冬季,HAst V感染主要在冬季,HEAdv感染沒(méi)有明顯的季節(jié)分布特征;2歲以下嬰幼兒為病毒性腹瀉的高危人群;病毒性腹瀉患兒臨床癥狀主要為腹瀉、嘔吐、發(fā)熱等,輪狀病毒是引起重癥腹瀉的主要病原;
[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;
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R725.1

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