2018－2023年浙江省宁海县柯萨奇病毒A组6型手足口病伴脱甲症相关因素研究

孔志芳; 杨斌; 胡伟丹; 倪红霞; 陈伟; 章海斌; 任丛汉; 张丹

doi:10.3784/jbjc.202408140476

2018－2023年浙江省宁海县柯萨奇病毒A组6型手足口病伴脱甲症相关因素研究

Incidence of onychomadesis and related factors in cases of hand foot and mouth disease caused by coxsackie virus A6 in Ninghai, Zhejiang, 2018−2023

摘要

摘要:
目的了解宁海县柯萨奇病毒A组6型（CVA6）相关手足口病（HFMD）脱甲特征，为今后CVA6-HFMD防控提供依据。
方法从中国疾病预防控制信息系统获取2018—2023年宁海县HFMD病例，按地理特征采集HFMD患者粪便、咽拭子、脱落甲碎片、未脱甲及新生甲标本，用荧光反转录聚合酶链式反应（RT-PCR）方法检测肠道病毒通用型及基因亚型；CVA6阳性的所有病例纳入调查对象，同时开展24周脱甲随访调查。
结果 1 336例CVA6-HFMD病例中533例出现了不同数量脱甲，脱甲症发生率为39.90%，平均脱甲6.02个，手指平均脱甲（3.86±3.01）个，脚趾（2.17±2.80）个；脱甲时间平均33.56 d，70.36%脱甲发生在15～42 d（3～6周）；脱甲症与未脱甲病例发病时间、性别、地区间差异均无统计学意义（χ²=0.321，P=0.956，χ²=2.778，P=0.096，χ²=2.314，P=0.679），与病例年龄组、发热、热程、皮疹部位（除口外）差异均有统计学意义（均P<0.001）；RT-PCR检测55份脱落甲CVA6阳性率为94.55%，未脱甲及新生甲均为阴性，脱甲病例接触人员中未出现CVA6-HFMD。
结论本研究CVA6-HFMD呈脱甲时间越早平均脱甲数越多特征；脱甲症与发病时间、地区、性别、微量元素、真菌无关，与病情严重程度、年龄有关，脱甲发生原因认为可能是CVA6病毒直接对指（趾）甲侵害，脱甲可能存在病毒侵犯到指（趾）甲发生脱甲，不侵犯不发生脱甲，脱甲期间可能无传染性。

Abstract:
Objective To better understand the characteristics of coxsachie virus A6 (CVA6)-caused hand, foot and mouth disease (HFMD) with onychomadesis in Ninghai county of Zhejiang province and provide evidence for the prevention/control of CVA6-caused HFMD in the future.
Methods From 1 January 2018 to 31 December 2023, the incidence data of HFMD in Ninghai were obtained from China Disease Prevention and Control Information System, and the stool samples and/or pharynx swabs, lost nail, nail and new nail samples of HFMD cases were collected in different areas in Ninghai for the detection of enteroviruses and nucleic acid typing by fluorescence reverse transcriptase polymerase chain reaction（RT-PCR）. All the cases with positive CVA6 nucleic acid results were included in the survey, and a 24-week follow-up survey was carried out.
Results In the 1336 cases of CVA6-caused HFMD, onychomadesis occurred in 533 cases (39.90%), the average nail count affected was 6.03, with an average of 3.86 ±3.01on fingers and 2.17±2.80 on toes, and 70.36% of onychomadesis occurred at day 15-42 (3-6W) after HFMD onset for an average of 33.56 days. There were no significant differences in the onset time, gender and area distributions between the cases of HFMD with onychomadesis and the cases of HFMD without onychomadesis（χ²=0.321, P=0.956, χ²=2.778, P=0.096, χ²=2.314, P=0.679）, but there were significant differences in age distribution, incidence of fever, fever duration and skin rash site (except mouth) (all P<0.001). RT-PCR indicated that the positive rate of CVA 6 in 55 samples of lost nail was 94.55%. Both nail and new nail samples were negative for CVA6. No CVA6-caused HFMD occurred in the contacts exposed to lost nails.
Conclusion The study results indicated that the earlier onychomadesis occurred, the more nails lost. Onychomadesis was not associated with the onset time, gender and area distributions of HFMD cases, trace elements and fungi, but associated with the severity and age of the cases. The incidence of onychomadesis might be explained by the direct invasion of CVA6 to finger or toe nail, and onychomadesis might not be associated with the spread of HFMD.

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