EV71型重症手足口病患儿的临床特征及危险因素的相关性分析

发布时间：2018-10-10 07:47

【摘要】：目的探讨人肠道病毒71型(EV71)重症手足口病(HFMD)患儿的临床特征及其感染发生的危险因素,为预防、临床诊治提供参考依据。方法回顾性分析2013年1月-2015年12月67例重症手足口病患儿的病例资料,用描述性方法进行流行病学分析;同时对患儿的一般资料、症状、体征、辅助检查进行回顾性分析,收集患儿发生感染的部位、细菌种类、药敏实验结果,分别采用实时荧光定量聚合酶链反应(q RT-PCR)方法对人肠道病毒普通型(EV)、EV71、柯萨奇病毒A16型(A16)进行检测。结果 67例EV71型重症HFMD患儿以单一感染最多,占50.7%(34例);EV71型的混合感染占49.3%(33例)。继发感染最常见部位是下呼吸道(26.5%)。临床分离病原体46株,其中革兰阳性菌11株(23.9%),革兰阴性菌35株(76.1%)。对病原体进行药敏实验,头孢曲松、亚胺培南、头孢哌酮/舒巴坦普遍对G-性菌敏感,头孢唑林钠、哌拉西林、万古霉素普遍对G+性菌敏感。EV71型重症HFMD以3岁内的男性患儿多见,5岁以上儿童发病率较低,春夏季为发病高峰期,患儿临床症状以高热、皮疹、嗜睡、易惊、肢体抖动、病理征阳性为主,常伴有胸片、头颅CT异常,实验检查结果显示心肌酶谱、肝功能、白细胞、血糖升高、体液免疫及降钙素原等异常;3岁以下的男性患儿、农村住宿条件差、不良卫生习惯、对该疾病不了解未采取预防措施的监护人的散居儿童为该疾病的高发人群,EV71为其感染的常见病原体。结论四川部分地区重症HFMD患儿主要由EV71及其混合型人肠道病毒感染引起,了解EV71型HFMD重症临床特征,掌握本地区EV71型重症HFMD的高危因素对于HFMD防治具有重要意义。
[Abstract]:Objective to investigate the clinical characteristics and risk factors of human enterovirus 71 (EV71) severe hand-foot-mouth disease (HFMD) in children, and to provide reference for prevention, clinical diagnosis and treatment. Methods 67 cases of severe hand, foot and mouth disease from January 2013 to December 2015 were retrospectively analyzed, and the general data, symptoms, signs and auxiliary examinations were analyzed retrospectively. The infection site, bacterial species and drug sensitivity test results were collected and real-time fluorescent quantitative polymerase chain reaction (Q RT-PCR) was used to detect human enterovirus (EV) EV71 and Coxsackie virus A16 (A16) respectively. Results the single infection was the most common in 67 cases of severe HFMD of EV71 type, accounting for 50.7% (34 cases), and the mixed infection of EV71 type was 49.3% (33 cases). The most common site of secondary infection was lower respiratory tract (26.5%). Among 46 clinical isolates, 11 were Gram positive bacteria (23. 9%), 35 were Gram negative bacteria (76. 1%). Ceftriaxone, imipenem, cefoperazone / sulbactam were generally sensitive to G-sex bacteria, cefazolin sodium, piperacillin, cefazolin, piperacillin, Vancomycin was generally sensitive to G sexual bacteria. EV71 type severe HFMD was more common in male children under 3 years of age. The incidence of vancomycin was lower in children over 5 years of age. The peak incidence of vancomycin in spring and summer was high fever, rash, lethargy, easy to panic and limb jitter. Pathological signs were mainly positive, often accompanied by abnormal CT in chest radiographs and cranium. The experimental results showed that myocardial enzyme spectrum, liver function, white blood cell, increased blood glucose, humoral immunity and procalcitonin were abnormal in male children under 3 years of age, and the living conditions in rural areas were poor. Poor hygiene habits, not understanding of the disease did not take preventive measures of the guardian of the diaspora children for the disease's high risk population EV71 as a common pathogen of their infection. Conclusion severe HFMD in some areas of Sichuan is mainly caused by EV71 and mixed human enterovirus infection. It is important for HFMD prevention and treatment to understand the clinical characteristics of EV71 type HFMD and to understand the high risk factors of EV71 type severe HFMD in this area.
【作者单位】：川北医学院附属医院感染科;首都医科大学;四川省疾病预防控制中心;
【分类号】：R725.1

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