2018年西安地区重症手足口病病原学及临床特点

Etiological and clinical characteristics of severe hand,foot and mouth disease in Xi'an in 2018

目的了解2018年西安地区重症手足口病(HFMD)病原学及临床特征,为其临床诊断与治疗提供依据.方法选择西安市儿童医院2018年1月至12月收治的重症HFMD患儿为研究对象,收集临床资料,采集其肛拭子,采用实时荧光定量聚合酶链反应(RT-PCR)法对患儿标本进行病毒检测.结果2018年西安市儿童医院共收治重症HFMD 95例,其中重型92例,危重型3例.病原学检测肠道病毒核酸阳性87例,血清学分型肠道病毒71型(EV71)30例(占31.6%),柯萨奇病毒A组6型(CA6)39例(占41.0%),柯萨奇病毒A组16型(CA16)3例(占3.2%),柯萨奇病毒A组10型(CA10)阳性2例(占2.1%),其他肠道病毒13例(占13.7%).95例重症HFMD患儿中,男女比例为1.1∶1.0;5-7月份为HFMD发病高峰期,3岁以下为重症HFMD主要发病年龄;临床表现中以精神差、呕吐、烦躁、嗜睡、易惊、抽搐为主要表现;CA6重症患儿易出现抽搐,皮疹形态以大疱样皮疹为主,恢复期可出现脱甲,EV71感染患儿皮疹表现为小、厚、硬、少;经积极治疗后仅1例EV71感染患儿因严重脑功能障碍、频繁抽搐、神经源性肺水肿家长放弃治疗后最终死亡,另1例出院时留有偏瘫、语言功能障碍,余重症患儿均临床治愈出院.结论2018年西安地区重症HFMD病原以CA6为主,皮疹以大疱表现为主,恢复期可出现脱甲.危重症及死亡病例仍为EV71引起.

Objective To understand the etiological and clinical characteristics of children with severe hand,foot and mouth disease(HFMD)in Xi'an in 2018,and to provide the evidence for clinical diagnosis and treatment.Methods The children with severe HFMD admitted at Xi'an Children's Hospital from January to December 2018 were selected as the research objects.Clinical data were collected,and the anal swab were detected by adopting real time(RT)-polymerase chain reaction(PCR).Results Ninety-five cases of HFMD were treated in Xi'an Children's Hospital in 2018,of which 92 cases were severe and 3 cases were critical.Eighty-seven cases were positive for enterovirus nucleic acid,30 cases were enterovirus 71(EV71)(31.6%),39 cases were coxsackievirus A6(CA6)(41.0%),3 cases were CA16(3.2%),2 cases were CA 10(2.1%)and 13 cases were other enteroviruses(13.7%).Among 95 patients,the ratio of male to female was 1.1∶1.0;the peak period of incidence of HFMD was from May to July,and the main age of onset of severe HFMD was under 3 years old.The main clinical manifestations were mental retardation,vomiting,irritability,lethargy and convulsion.Severe cases of CA6 are prone to convulsion.The main form of rash in CA6 cases was bullous rash,and demethylation may occur in recovery period.The rash in EV71 cases was small,thick,hard and few.After active treatment,only one child with EV71 infection died because of severe cerebral dysfunction,frequent convulsions and neurogenic pulmonary edema.The other child was discharged with hemiplegia and language dysfunction.The other severe children were cured and discharged from hospital.Conclusions In 2018,CA6 was the main pathogen of severe HFMD in Xi'an,with bullae was the main manifestation of skin rash,and nail removal could occur during convalescence.Critical and death cases were still caused by EV71.