- 學位論文
非小兒麻痺腸病毒(NPEV)之分子流行病學監測與調查研究
THE STUDY OF MOLECULAR EPIDEMIOLOGY ON NON-POLIO TYPE ENTEROVIRUS
摘要
腸病毒可經由腸道感染，因此統稱為「腸病毒」。台灣地區因位在亞熱帶，自1998年以來台灣地區每逢夏秋兩季即有大小規模不等的腸病毒流行。本研究蒐集2005年4月至10月台北市各醫院之疑似腸病毒小兒患者咽喉檢體總數200例，並利用RT-PCR之分子生物法快速分析腸病毒之型別與流行病學調查。結果顯示以RT-PCR法檢測呈陽性反應者佔了46.5 % ( 93/200 )，經由Seminest-PCR及Nest-PCR雙重確認後則陽性率提升為68.0 % ( 136/200 )。該年度台北市腸病毒流行曲線呈現一大一小雙峰波動的趨勢。第一波疫情自四月份起開始有病例出現至六月份達到顛峰，七月份至九月份則逐漸趨緩，第二波疫情出現於十月。經由統計檢定結果顯示性別、年齡分布與生活環境在所收集之檢體中並無顯著差異。 本研究中調查感染腸病毒症所產生之症狀以發燒(86.8%)、口腔潰瘍(83.8%)、食慾不振(66.9%)、手雙足起水泡(62.5%)、皮膚疹(52.9%)、咳嗽(35.3%)與睡眠不佳(27.2%)為主。自2005/04月-2005/10月，本研究中136名確定為腸病毒感染的患者鑑定其病毒型別及其所佔百分比為CA16：52.0% (72/136)；EV71：11.0% (16/136)；CA6與ECV11的檢出率相同，皆為9.0% (12/136)；CA2：6.0% (8/136)；CB1：3.0% (4/136)；CA10：2.0% (3/136)；ECV6、ECV30、CA4與CA5的檢出率相同，皆為1% (1/136)，另有5株未分型，佔4.0%。本年度所分離鑑定之腸病毒七十一型(EV71)病毒其5’NCR序列經分子演化分析，結果呈現總數16株病毒株分屬三群(Group A、B與D)，其中只有一株(C-207)屬於1998年台灣大流行之病毒群 ( Group B)，而Group A包括11株本年分離之EV71，且與中國分離株具最近之親緣關係。然而Group D中4株檢體似乎屬於台灣本土特有株。
關鍵字
腸病毒並列摘要
Enterovirus infect the gastrointestinal tract .Taiwan is located in temperate climates, so that there were enterovirus cases increased circulation in summer and early fall since 1998. Due to the diversity of disease manifestations, diagnoses cannot be made on clinical grounds alone. However, recent developments in molecular detection technology make it probable that enterovirus diagnosis will increasingly be achieved by non-culture-based methods, particularly nucleic acid amplification methods such as PCR. In this study, we combined RT-nested-PCR and molecular epidemiological method to detect and identify total 200 suspected enterovirus cases that collected from hospital of Taipei city during 2005 April and 2005 October. The result showed that RT-PCR positive detection rate for enterovirus was 46.5% (93/200 ) and also confirmed true positive detection rate for enterovirus was 68 % (136/200) by Seminest- and Nest-PCR. There are two seasonal peaks appeared in April-June and October within Taipei area. According to the analysis of statistic method, it showed that there were no significant difference for enterovirus infectious rate between Sexual、Age and environmental conditions. The major clinical syndrome for those enterovirus-positive patients are fever (86.8 %) 、vesicular lesions on mouth ( 83.8 % )、poor appetite (66.9%)、vesicular lesions on hands and foots (62.5%)、skin rash (52.9%)、cough (35.3%) and unusual sleepiness (27.2%). Total 136 clinical samples of Non-polio enterovirus from 2005 April to October were analyzed by sequence analysis and then identify serotype. The result showed that there are 11 serotype detected in this study. The distribution percentage of each serotype was CA16：52.0% (72/136)；EV71：11.0% (16/136)；CA6：9.0% (12/136)；ECV11：9.0% (12/136)；CA2：6.0% (8/136)；CB1：3.0% (4/136)；CA10：2.0% (3/136)；ECV6、ECV30、CA4 and CA5, 1% (1/136), unknown type,4.0%, respectively. The molecular evolution result of 5’NCR sequence of total 16 clinical samples isolated from this study were clustered as three major subgroup (Subgroup A、B and D).There was only one sample (C-207) belonged to 1998 outbreak of enterovirus 71 in Taiwan ( Subgroup B).Subgroup A ( include 11 isolates of EV71) were more closely related to the epidemic strain that isolated from China. However it showed that Subgroup D, includes 4 clinical samples, were classified as one unique subgroup specific for Taiwan isolates.