散发6例婴幼儿无皮疹型肠道病毒71型感染致肺出血的临床特征

Clinical features of six sporadic eases of infant pulmonary hemorrhage of enterovirus 71 infection without skin rash

目的了解婴幼儿无皮疹型肠道病毒71型（EV71）感染致肺出血病例的临床特征，提高临床医师对该病的认识水平。方法回顾分析2007年11月至2008年10月间确诊的6例无皮疹型EV71感染致肺出血病例的临床特征、转归及治疗过程，实验室检测指标和胸部影像学改变等。结果6例患儿均〈2岁，全年散发，无发病高峰，经咽部和气管插管内分泌物RT—PCR和实时荧光PCR检查均证实为EV71感染。发病初期均有发热，4例伴呕吐，2例伴咳嗽，1～3d后病情骤然恶化，6例均表现为脸色苍白，口唇发绀，1例伴发惊厥，气管插管内均见大量血性泡沫液。6例血糖显著升高，4例有心动过速，2例血压升高。6例患儿均死亡，其中4例恶化后6h内死亡。结论无皮疹型EV71感染致肺出血见于婴幼儿，全年散发，疾病呈暴发性，多于短期内死亡。

Objective To understand the clinical features of infant pulmonary hemorrhage of enterovirus 71 infection without skin rash, and to improve the diagnosis and treatment of this disease. Methods Six infants infected with enterovirus 71 and presented pulmonary hemorrhage but no skin rash between November 2007 and October 2008 were retrospectively reviewed. The clinical manifestations, clinical outcomes, treatments, laboratory data and chest imaging changes of the cases were analyzed. Results The 6 cases were all younger than 2 years old. The cases distributed throughout the whole year without peak season. Enterovirus 71 gene was detected by reverse transcription-polymerase chain reaction （RT-PCR） and real time polymerase chain reaction from throat swabs and secretions of the respiratory tract. All the cases began with fever, and 4 of which were accompanied with vomit, and 2 accompanied with cough. After 1 to 3 days, they all got sudden deterioration, manifested with pale and cyanosis, and 1 had hyperspasmia. After intubation, they all had pink frothy fluid from the endotracheal tube. They all had obvious hyperglycaemia, 4 had tachycardia, and 2 had hypertension. All the 6 cases died, and 4 died within 6 h after deterioration. Conclusions Pulmonary hemorrhage of enterovirus 71 infection without skin rash is seen in infants. It is sporadic throughout the whole year. The disease is fulminant and the case often dies in short period of time.