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

Clinical features of children with type EV71 severe hand, foot and mouth disease and correlation analysis of risk factors

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（qRT-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 explore the clinical features of children with severe hand, foot and mouth disease caused by human enterovirus 71 (EV71) and its risk factors for infection, and provide reference for the prevention, clinical diagnosis and therapy. Methods The clinical data of 67 children with severe hand, foot and mouth disease between January 2013 and December 2015 were retrospectively analyzed using the method of descriptive epidemiological analysis. At the same time, the patients' general information, symptoms, signs and auxiliary examination and outcome were retrospectively analyzed; the infected sites, type of bacteria and drug sensitivity test results were collected.qRT-PCR was used to test conventional type of enterovirus(EV), enterovirus71 (EV71), and Coxsackie virus A16(A16). Results Of the 67 children with severe hand, foot and mouth disease, 34 cases were only infected by EV71(50.7%), and 33 patients had EV71 mixed infection (49.3%). Secondary infections most commonly appeared in the lower respiratory tract (26.5%). There were 46 strains of pathogens isolated in clinic, of which 11 strains were Grampositive bacteria (23.9%) and 35 strains were Gram-negative bacteria (76.1%). Drug susceptibility tests revealed that Gram-negative bacteria were generally sensitive to Ceftriaxone, Imipenem, Cefoperazone and Sulbactam, while Gram-positive bacteria were generally sensitive to Cefazolin sodium, Piperacillin and Vancomycin. EV71 type severe hand, foot and mouth disease was often seen in boys under 3 years of age, rarely occurred in children over the age of 5. The peak onset was in spring and summer, The clinical symptoms mainly included high fever, rash, drowsiness, hyperarousal, limb jitter and positive pathological signs, often accompanied by abnormalities in chest radiograph and cranial CT. The experimental results showed markedly increased myocardial enzymes, liver function indexes, WBC and blood glucose, and abnormal humoral immunity and procalcitonin. Male children under the age of 3, children with poor rural housing condition and bad health habits, and children without taking preventive measures for the disease because the guardians had no knowledge of the disease were the high-risk groups for the disease, the common pathogen of infection was EV71. Conclusions In some areas of Sichuan, severe hand, foot and mouth disease in children is mainly caused by EV71 infection and EV71 mixed infection. Understanding the clinical characteristics of severe hand, foot and mouth disease and knowing well the risk factors are of great significance for the prevention and control of the disease.