本文選題：腸道病毒71型 + 中樞神經(jīng)系統(tǒng)損害��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：背景:EV71是腸道病毒屬小RNA病毒科成員之一,是無包膜、無突起的單股正鏈RNA病毒,主要包括4種結(jié)構(gòu)蛋白、7種非結(jié)構(gòu)蛋白和核糖核酸。EV71感染是全球性傳染性疾病,近年來在亞太地區(qū)流行呈上升趨勢(shì),特別是我國內(nèi)地地區(qū)。EV71感染大多數(shù)癥狀輕微,主要表現(xiàn)為手足口病或者皰疹性咽峽炎,以手、足、口腔、臀部紅色斑丘疹或者皰疹為主要特征;少數(shù)可導(dǎo)致嚴(yán)重中樞神經(jīng)系統(tǒng)疾病發(fā)生,如腦脊髓炎、腦干腦炎、神經(jīng)源性肺水腫、急性遲緩性麻痹等,致死率和致殘率高,嚴(yán)重影響兒童的生活質(zhì)量。本研究目的是分析EV71感染導(dǎo)致中樞神經(jīng)系統(tǒng)損害的相關(guān)因素,并明確是否為中樞神經(jīng)系統(tǒng)損害程度的危險(xiǎn)因素。方法:本研究納入212例手足口病流行期間于青島大學(xué)附屬醫(yī)院和青島市婦女兒童醫(yī)院確診的EV71感染患者,其中男112例(52.83%),女100例(47.17%),年齡范圍為0.5-9.7歲,所有研究對(duì)象糞便標(biāo)本經(jīng)反轉(zhuǎn)錄-聚合酶鏈反應(yīng)(RT-PCR)技術(shù)檢測(cè)為EV71核酸陽性。根據(jù)是否引起中樞神經(jīng)系統(tǒng)疾病,將研究對(duì)象分為腦炎組(n=69)和非腦炎組(n=143),其中腦炎組男35例(50.7%)、女34例(49.3%),平均年齡為4.17±1.81(歲),非腦炎組男76例(53.1%)、女67例(46.9%),平均年齡為4.18±2.09(歲);根據(jù)中樞神經(jīng)系統(tǒng)臨床癥狀表現(xiàn)輕重,將腦炎組分為輕癥組(n=63)和重癥組(n=6),其中輕癥組男32例(50.8%)、女31例(49.2%),平均年齡為4.05±1.66(歲),重癥組男3例(50.0%)、女3例(50.0%),平均年齡為5.37±2.87(歲)。符合正態(tài)分布的資料用均數(shù)±標(biāo)準(zhǔn)差(`x±s)表示,組間比較采用兩獨(dú)立樣本t檢驗(yàn);非正態(tài)分布數(shù)據(jù)由中位數(shù)和四分位數(shù)(P25、P75)來表示,組間比較采用Mann-Whitney U檢驗(yàn);定性資料用百分構(gòu)成比表示,組間比較采用χ2檢驗(yàn),以95%可信區(qū)間(95%CI)和比值比(OR)表示危險(xiǎn)度。所有統(tǒng)計(jì)學(xué)資料采用SPSS17.0軟件處理,p0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果:腦炎組與非腦炎組、輕癥組與重癥組在性別上差異無統(tǒng)計(jì)學(xué)意義(χ2=0.109,p=0.741 vs.χ2=0.001,p=0.970);同時(shí)腦炎組與非腦炎組、輕癥組與重癥組在年齡上無統(tǒng)計(jì)學(xué)差異(t=0.042,p=0.966 vs.t=1.105,p=0.316)。腦炎組白細(xì)胞計(jì)數(shù)明顯高于非腦炎組(9.46±4.52 vs.8.27±2.06,t=2.598,p=0.011),且重癥組白細(xì)胞計(jì)數(shù)明顯高于輕癥組(12.62±3.56 vs.9.16±3.39,t=2.374,p=0.02),經(jīng)Logistic回歸分析,發(fā)現(xiàn)白細(xì)胞計(jì)數(shù)是中樞神經(jīng)系統(tǒng)損害發(fā)生和中樞神經(jīng)系統(tǒng)損害程度的危險(xiǎn)因素(p=0.003,OR=1.184,95%CI=1.059-1.324 vs.p=0.033,OR=1.343,95%CI=1.024-1.762)。腦炎組CRP明顯高于非腦炎組(6.93±4.84 vs.5.07±3.44,t=2.865,p=0.005),重癥組CRP明顯高于輕癥組(10.63±5.19 vs.6.58±4.69,t=2.008,p=0.049),經(jīng)Logistic回歸分析,發(fā)現(xiàn)CRP是發(fā)生中樞神經(jīng)系統(tǒng)損害的危險(xiǎn)因素(p=0.002,OR=1.121,95%CI=1.042-1.205),但不是中樞神經(jīng)系統(tǒng)損害程度的危險(xiǎn)因素(p=0.063,OR=1.190,95%CI=0.991-1.429)。與非腦炎組相比,腦炎組發(fā)熱時(shí)間較長(P50=3.00 vs.P50=1.50,z=5.134,p=0.000);腦炎組內(nèi)重癥組發(fā)熱持續(xù)時(shí)間明顯長與輕癥組(7.5±2.17 vs.2.88±1.59,t=6.592,p=0.000),經(jīng)Logistic回歸分析,發(fā)現(xiàn)發(fā)熱持續(xù)時(shí)間是中樞神經(jīng)系統(tǒng)損害發(fā)生和中樞神經(jīng)系統(tǒng)損害程度的危險(xiǎn)因素(p=0.000,OR=1.449,95%CI=1.212-1.734 vs.p=0.004,OR=3.578,95%CI=1.496-8.556)。腦炎組血糖明顯高于非腦炎組(P50=5.79 vs.P50=5.16,z=4.941,p=0.000),腦炎組內(nèi)重癥組血糖明顯高于輕癥組(8.40±0.75 vs.5.96±1.14,t=5.100,p=0.000),經(jīng)Logistic回歸分析,發(fā)現(xiàn)血糖水平高低是中樞神經(jīng)系統(tǒng)損害發(fā)生和中樞神經(jīng)系統(tǒng)損害程度的危險(xiǎn)因素(p=0.000,OR=1.973,95%CI=1.491-2.610 vs.p=0.006,OR=6.504,95%CI=1.723-24.559)。另外,腦炎組肌酸激酶同工酶高于非腦炎組(P50=16.0 vs.P50=12.0,z=4.959,p=0.000),經(jīng)Logistic回歸分析,發(fā)現(xiàn)肌酸激酶同工酶是中樞神經(jīng)系統(tǒng)損害發(fā)生的危險(xiǎn)因素(p=0.003,OR=1.046,95%CI=1.015-1.078);腦炎組內(nèi)重癥組熱峰高于輕癥組(38.8±0.46 vs.38.2±0.68,t=2.507,p=0.015),經(jīng)Logistic回歸分析,發(fā)現(xiàn)熱峰高低是中樞神經(jīng)系統(tǒng)損害程度的危險(xiǎn)因素(p=0.036,OR=3.684,95%CI=1.088-12.471)。結(jié)論:EV71感染導(dǎo)致中樞神經(jīng)系統(tǒng)損害與年齡、性別無相關(guān)關(guān)系;與非腦炎組相比,腦炎組白細(xì)胞數(shù)、C反應(yīng)蛋白、發(fā)熱持續(xù)時(shí)間、血糖、肌酸激酶同工酶升高或延長;與輕癥腦炎組相比,重癥腦炎組白細(xì)胞計(jì)數(shù)、發(fā)熱持續(xù)時(shí)間、熱峰、血糖升高或延長。
[Abstract]:Background : EV71 is one of the members of the small RNA virus of Enterovirus , which is a non - enveloped , non - protruding , single - strand RNA virus , which mainly includes four structural proteins , seven non - structural proteins and ribonucleic acid . The mean age was 4.05 鹵 1.66 ( years ) . The mean age was 5.37 鹵 2.87 ( years ) . The mean age was 5.37 鹵 2.87 ( years ) . The WBC count was significantly higher in the encephalitis group than in the non - encephalitis group ( 9.46 鹵 4.52 vs . 8.27 鹵 2.06 , t = 2.598 , p = 0 . 011 ) , and the WBC count in the severe group was significantly higher than that in the mild group ( 12.62 鹵 3.56 vs . 9.16 鹵 3.39 , t = 2.374 , p = 0.02 ) . By Logistic regression analysis , it was found that the white blood cell count was a risk factor for the occurrence of the central nervous system injury and the degree of damage to the central nervous system ( p = 0.003 , OR = 1.184 , 95 % CI = 1.059 - 1.324 vs . p = 0.033 , OR = 1.343 , 95 % CI = 1.024 - 1.762 ) . CRP was significantly higher than that in the non - encephalitis group ( 6.93 鹵 4.84 vs . 5.07 鹵 3.44 , t = 2.865 , p = 0.005 ) . The CRP in the severe group was significantly higher than that in the mild group ( 10.63 鹵 5.19 vs . 6.58 鹵 4.69 , t = 2.008 , p = 0.049 ) , but was not a risk factor for the damage to the central nervous system ( p = 0.063 , OR = 1.190 , 95 % CI = 0.991 - 1.429 ) . Compared with non - encephalitis group , the fever duration of the encephalitis group was longer ( P50 = 3.00 vs . P50 = 1.50 , z = 5.134 , p = 0.000 ) ; the duration of fever in the severe group in the encephalitis group was significantly longer than that in the mild group ( 7.5 鹵 1.17 vs . 2.88 鹵 1 . 59 , t = 6.592 , p = 0.000 ) , and the Logistic regression analysis showed that the duration of fever was the risk factor of the occurrence of the central nervous system injury and the degree of damage to the central nervous system ( p = 0.000 , OR = 1.449 , 95 % CI = 1.212 - 1.734 vs . p = 0.004 , OR = 3.578 , 95 % CI = 1.496 - 8.556 ) . The blood glucose in the encephalitis group was significantly higher than that in the non - encephalitis group ( P50 = 5.79 vs . P50 = 5.16 , z = 4.941 , p = 0.000 ) . The blood glucose levels in the severe group in the encephalitis group were significantly higher than those in the mild group ( 8.40 鹵 0.75 vs . 5.96 鹵 1.14 , t = 5.100 , p = 0.000 ) . By Logistic regression analysis , it was found that the level of blood glucose was the risk factor of the central nervous system injury and the degree of central nervous system injury ( p = 0.000 , OR = 1.973 , 95 % CI = 1.491 - 2.610 vs . p = 0.006 , OR = 6.504 , 95 % CI = 1.723 - 24.559 ) . In addition , the creatine kinase isoenzyme of the encephalitis group was higher than that of non - encephalitis group ( P50 = 16.0 vs . P50 = 12.0 , z = 4.59 , p = 0.000 ) . After Logistic regression analysis , it was found that creatine kinase isoenzyme was a risk factor for the damage to the central nervous system ( p = 0.003 , OR = 1.046 , 95 % CI = 1.015 - 1.078 ) . The risk factors of the degree of injury of the central nervous system were found by Logistic regression analysis ( p = 0.036 , OR = 3.684 , 95 % CI = 1.088 - 12.471 ) . Conclusion : EV71 infection has no correlation with age and sex . Compared with non - encephalitis group , the number of white blood cells , C - reactive protein , fever duration , blood sugar and creatine kinase isoenzyme of the encephalitis group are increased or prolonged . Compared with the group with mild encephalitis , the white blood cell count , the duration of fever , the hot peak , the blood sugar increase or extend .

【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R725.1

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