西安地区36例危重型手足口病患者临床特征分析

Clinical Features of 36 Critical Cases with Hand-Foot-and-Mouth Disease in Xi'an District

目的了解近年来危重型手足口病(HFMD)患儿临床特征及变化,为临床诊断与治疗提供依据。方法收集36例危重型HFMD患儿临床资料,包括年龄、性别、症状、体征、实验室检查及临床转归情况。结果 36例患儿中男22例,女14例,男女比例1.57:1,3岁以内患儿33例(91.67%),5～7月份发病23例(63.89%),城乡比例为1:8。表现为皮疹36例(100%)、发热35例(97.22%)、肺部啰音30例(83.33%)、呕吐27例(75.00%)、肢体抖动17例(47.22%)、Babinski征阳性17例(47.22%)、休克13例(36.11%)。34例(94.44%)为肠道病毒71型(EV71)感染,18例合并流感病毒感染,23例血白细胞升高,24例出现高血糖,15例合并腺病毒感染。19例死亡病例中13例出现高血糖,13例血白细胞升高。结论 3岁以内婴幼儿为危重型HFMD病高危人群,5～7月为高峰季节。EV71感染是危重型手足口病的主要病原;外周血白细胞升高、高血糖是预测病情进展及预后的主要危险因素,应引起高度重视。EV71合并流感病毒感染、腺病毒感染可能是导致手足口病病情加重的危险因素。

Objective To survey the clinical features of hand-foot-and-mouth disease （HFMD） in Xi＇an district in recent years. Methods A total of 36 cases of HFMD were investigated on the patient＇s age,gender,clinical mani- festation,laboratory examination and clinical outcomes. Results Of all 36 children, there were 22 boys and 14 girls with the ratio 1.6：1. The critical HFMD patients younger than 3-year-old were 33 cases（91.67%）and 23 cases （63.89%） occurred during May to July. The ratio of the proportion between urban and rural areas was 1：8.There were 36 cases （100%） had rash, 35 cases （97.22%） had fever, 30 cases （83.33%） were found pulmonary rales,27cases（75.00%） had vomiting, 17 cases （47.22%） had myoclonus and Babinski positive, and 13 cases（36.11%） occurred shock in 36 children. Thirty-four cases（94.44%）were infected by EV71,18 cases combined influenza virus,23 cases had leucocytosis,and 24 cases had hyperglycaemia. Of the 19 fatal cases, 13 cases were found hyperglycaemi and 13 cases were found leucocytosis. Conclusion Infants younger than under 3 years old are most susceptible population to HFMD. The peak time of HFMD was during May-July. EVT1 infection was associated with most critical cases. Hyperglycaemia and leucocytosis were the prediction and risk factors of critical cases and should be paid much attention to. EVT1 combined with influenza virus or adenovirus infection may contribute to the progress of the disease.