珠海市0～6岁儿童手足口病调查分析

Investigation of hand-foot-and-mouth disease in children aged 0 to 6 in Zhuhai

目的探讨珠海市0~6岁儿童手足口病发病情况,为珠海市手足口病的防控提供科学依据。方法以整群随机抽样法选取2015年5月至2017年10月珠海市2456例0~6岁手足口病患儿为研究对象,采集受检者新鲜粪便进行肠道病毒检测,采集空腹静脉血检测T淋巴细胞和儿茶酚胺类激素以及常规生化项目。结果 2456例手足口病患儿以3岁及以下幼儿为主,占73.66%(1809/2456);男女患病比例为1.62:1;发病高峰期为夏秋季;2456例患儿中检出肠道病毒534例(21.74%),其中柯萨奇病毒A组16型(CVA16)感染52例(2.12%),肠道病毒71型(EV71)感染445例(18.12%),其他肠道病毒感染37例(1.51%)。2456例患儿中重症病例318例,普通病例2138例。重症病例的总病毒检出率及EV71病毒检出率均高于普通病例,差异有显著性(P<0.05);重症病例的CD3^+、CD3^+CD8^+、CD3^+CD4^+、CD3^+CD16^+CD25^+T细胞百分比明显低于普通病例,差异有显著性(P<0.05);普通病例的外周血去甲肾上腺素、肾上腺素、多巴胺、乳酸、血糖、天门冬氨酸氨基转移酶、肌酸激酶同工酶、乳酸脱氢酶水平均低于重症病例,差异有显著性(P<0.05)。结论珠海市0~6岁儿童手足口病以3岁及以下幼儿多见,夏秋季为好发季节,EV71是引起重症手足口病的主要病原体,临床治疗中应加以重视。重症手足口病患儿多伴有免疫功能紊乱或低下,检测与机体代谢、免疫功能相关的实验室指标,可有效反映机体在肠道病毒感染后的生理与病理变化,对防治手足口病具有重要意义。

Objective To investigate the situations of hand foot and mouth disease（HFMD） in children aged 0 to 6 in Zhuhai, and to provide basis for HFMD control measures in Zhuhai. Method 2456 HFMD children aged 0 to 6 in Zhuhai from May 2015 to October 2017 were selected by cluster random sampling. The fresh excreta of selected cases were obtained and given enterovirus detection. The fasting venous blood of selected cases were collected, and they were given T lymphocyte, catecholamine hormones and routine biochemistry test. Result The occurrence of HFMD was mainly in children aged 3 or below among 2456 cases, which accounted for 73.66%（1809/2456）; The ratio of male to female was 1.62：1; The peak of onset was summer and autumn; There were 534 cases of enterovirus（21.74%） in 2456 children, including 52 cases of coxsackievirus A group 16 Strain（CVA16）（2.12%）, 445 cases of enterovirus type 71（EV71）（18.12%） and 37 cases of other enterovirus（1.51%）; There were 318 severe cases and 2138 normal cases in 2456 cases of children; The detection rate of EV71 and total detection rate of virus in severe cases were higher than those in normal cases（P〈0.05）; The levels of CD3-＋, CD3-＋CD8-＋, CD3-＋CD4-＋, CD3-＋CD16-＋CD25-＋ T cells in severe cases were higher than those in normal cases（P〈0.05）; The levels of norepinephrine（NE）, epinephrin（E）, dopamine（DA）, lactic acid（LAC）, glucose（Glu）, aspartate aminotransferase（AST）, creatine kinase MB（CKMB）, lactate dehydrogenase（LDH） in normal cases were lower than those in severe cases（P〈0.05）. Conclusion HFMD children aged 0 to 6 in Zhuhai are mainly in children aged 3 or below, and peak of onset is in summer and autumn, EV71 is major pathogen of severe HFMD, so that is is necessary to pay attention to clinical treatment; Severe HFMD children usually have immune dysfunction or immune hypofunction, the detection of body metabolism and immune function-related indexes can effectively reflect physiological and pathological changes after enterovirus infection, which has important significance in HFMD prevention.