【摘要】 目的 研究2014至2018年中河北省肺炎链球菌血清型分布与动态变迁，分析疫苗覆盖率。方法 应用多重聚合酶链式反应对菌株进行血清分型；计算PCV7、PCV10、PCV13、PPV23疫苗的覆盖率，使用卡方检验和Bonferroni检验，进行差异比较。结果 可分型菌株中较多的血清型包括：19F(176株33.40%)、6(87株16.51%)、19A(57株10.82%)、14(30株5.69%)、23F(20株3.80%)。19F型和19A型在非侵袭性菌株中占比高于侵袭性(P<0.05);14型在侵袭性菌株中比例明显高于非侵袭性菌株(P<0.05)。19F 2015年达到高点后开始下降；2017至2018年出现了19A比例回升、6群下降和14型明显上升。PCV7、PCV10、PCV13、PPV23的总体覆盖率依次为60.34%、64.33%、78.37%、83.30%, PCV13和PCV23显著高于PCV7和PCV10(P<0.05)。结论 本地2014至2018年间优势血清型依次为：19F、6、19A、14、23F型。对于本地区肺炎链球菌引发的感染，19F型和19A型菌株起到的作用可能会下降，引起的症状可能会减轻。相反，6群和14型起的作用会上升，引起的症状也可能会加重。推荐使用PCV13替代PCV7和PCV10,对于>2岁儿童也推荐使用PPV23。更多还原

【Abstract】 Objective To investigate the serotype distribution and dynamic changes of Streptococcus pneumoniae in Hebei province from 2014 to 2018,and to analyze the vaccine coverage rate.Methods The strains were serotyped by the multiple polymerase chain reaction.And the coverage of PCV7,PCV10,PCV13 and PPV23 vaccines was calculated, and the results were statistically analyzed to compare the differences.Results The main serotypes in the strains that could be classified included: 19 F(176 strains, 33.40%),6(87 strains, 16.51%),19 A(57 strains, 10.82%),14(30 strains, 5.69%) and 23 F(20 strains, 3.80%).The proportion of 19 F and 19 A in non-invasive strains was significantly higher than that in invasive strains.On the contrary, the proportion of type 14 was lower.The proportion of 19 F began to decrease after reaching th epeak in 2015.During 2017-2018,the proportion of 19 A was increased, 6 groups were decreased and 14 types were increased significantly.The coverage rates of PCV7,PCV10,PCV13 and PPV23 were 60.34%, 64.33%, 78.37% and 83.30% respectively. Moreover the coverage rates of PCV13 and PCV23 were significantly higher those of PCV7 and PCV10.Conclusion The local dominant serotypes in Shijiazhuang from 2014 to 2018 were in order of 19 F,6,19 A,14 and 23 F.In Streptococcus pneumoniae infection, the role of 19 F and 19 A strains may decrease, and the symptoms caused by them may be alleviated.On the contrary, the role of types 6 and 14 may increase, and the symptoms caused by them may be aggravated.It is recommended to use PCV13 instead of PCV7 and PCV10,and PPV23 is recommended for children over 2 years of age.更多还原