手足口病毒和白细胞分类的探讨*

Analysis of hand-foot-mouth disease and leukocyte differential count*

摘要:

目的 探讨手足口病患儿血常规的特点及其在预测病情方面的价值。方法 收集2015年4月—2018年7月四川绵阳四〇四医院诊断为手足口病患儿基本信息，以及他们在四川绵阳四〇四医院患病期间的血常规检测结果，主要是白细胞（WBC）、中性粒细胞（N）、淋巴细胞（L）和单核细胞（M），将肠道病毒71型（EV71）阳性、柯莎奇病毒A16型（CVA16）阳性与正常组的结果进行差异性分析，并采用受试者工作特征（ROC）曲线评价各指标对EV71阳性、CVA16阳性的预测价值。结果 选取手足口病患儿7?342例，病毒检出例数男性多于女性，以幼儿阶段（1～3岁）检出人数最多，学龄前阶段（>3～6岁）次之，各年龄段的检出率差异有统计学意义（P?<0.05）。EV71和CVA16阳性者WBC、L和M较正常组升高（P?<0.05），且CVA16组的M值高于EV71组（P?<0.05）。L在EV71和CVA16中的曲线下面积（AUC）为0.865（95% CI：0.832，0.897）和0.865（95% CI：0.840，0.889），敏感性和特异性分别为73.42%、96.55%和75.22%、96.55%。M在EV71和CVA16的曲线下面积分别为0.617和0.672，敏感性和特异性分别为48.50%、93.10%和54.74%、93.10%。结论 WBC、N、L和M对CVA16和EV71感染有一定的诊断指导价值，其中L的感染预测价值最高，M次之。在鉴别CVA16和EV71感染时，M具有一定的预测价值。

Abstract:

Objective To explore the characteristics of blood routine and the value of predicting the disease of children with hand-foot-mouth disease (HFMD) in this area. Method The basic information and the routine blood test results of children with hand-foot-mouth disease diagnosis were collected from April 2015 to July 2018. The routine blood test mainly included white blood cells, neutrophils, lymphocytes and monocytes. The difference of positive EV71, CVA16 and the normal group were analyzed by one-way ANOVA. ROC curve was used to evaluate positive predictive value of each index for EV71, CVA16. Results The total of 7?342 children with HFMD were collected. The virus detection quantity was higher in males than females, with the highest detection rate in infants (1 to 3 years old) and the second highest in preschool (>3 to 6 years old). There was significant difference in the detection rate of each age group (P?