【摘要】：目的探討人腸道病毒71型(EV71)重癥手足口病(HFMD)患兒的臨床特征及其感染發(fā)生的危險(xiǎn)因素,為預(yù)防、臨床診治提供參考依據(jù)。方法回顧性分析2013年1月-2015年12月67例重癥手足口病患兒的病例資料,用描述性方法進(jìn)行流行病學(xué)分析;同時(shí)對患兒的一般資料、癥狀、體征、輔助檢查進(jìn)行回顧性分析,收集患兒發(fā)生感染的部位、細(xì)菌種類、藥敏實(shí)驗(yàn)結(jié)果,分別采用實(shí)時(shí)熒光定量聚合酶鏈反應(yīng)(q RT-PCR)方法對人腸道病毒普通型(EV)、EV71、柯薩奇病毒A16型(A16)進(jìn)行檢測。結(jié)果 67例EV71型重癥HFMD患兒以單一感染最多,占50.7%(34例);EV71型的混合感染占49.3%(33例)。繼發(fā)感染最常見部位是下呼吸道(26.5%)。臨床分離病原體46株,其中革蘭陽性菌11株(23.9%),革蘭陰性菌35株(76.1%)。對病原體進(jìn)行藥敏實(shí)驗(yàn),頭孢曲松、亞胺培南、頭孢哌酮/舒巴坦普遍對G-性菌敏感,頭孢唑林鈉、哌拉西林、萬古霉素普遍對G+性菌敏感。EV71型重癥HFMD以3歲內(nèi)的男性患兒多見,5歲以上兒童發(fā)病率較低,春夏季為發(fā)病高峰期,患兒臨床癥狀以高熱、皮疹、嗜睡、易驚、肢體抖動(dòng)、病理征陽性為主,常伴有胸片、頭顱CT異常,實(shí)驗(yàn)檢查結(jié)果顯示心肌酶譜、肝功能、白細(xì)胞、血糖升高、體液免疫及降鈣素原等異常;3歲以下的男性患兒、農(nóng)村住宿條件差、不良衛(wèi)生習(xí)慣、對該疾病不了解未采取預(yù)防措施的監(jiān)護(hù)人的散居兒童為該疾病的高發(fā)人群,EV71為其感染的常見病原體。結(jié)論四川部分地區(qū)重癥HFMD患兒主要由EV71及其混合型人腸道病毒感染引起,了解EV71型HFMD重癥臨床特征,掌握本地區(qū)EV71型重癥HFMD的高危因素對于HFMD防治具有重要意義。
[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.
【作者單位】： 川北醫(yī)學(xué)院附屬醫(yī)院感染科;首都醫(yī)科大學(xué);四川省疾病預(yù)防控制中心;
【分類號(hào)】：R725.1

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