重症手足口病782例临床治疗及病原学分析

Treatment and etiology analysis of 782 cases of severe hand-foot and mouth disease

目的探讨重症手足口病的病原学并总结其临床诊治经验。方法对昆明市儿童医院2010年1月至12月收治住院的1304例手足口病惠儿中的782例（59．97％）重症病例（均并发脑炎）的临床特征、治疗、转归及病原学分析进行回顾性分析。结果782例惠儿中734例患儿粪便行半巢式RT-PCR核酸检测并测序：检出病原565例（76．98％），阴性124例，无同源45例；其中柯萨奇病毒A组16型（CoxAl6）306例（54．16％），肠道病毒71（Ev71）型220例（38．94％）。经积极有效治疗，除3例神经源性肺水肿抢救无效死亡外，775例临床症状消失，治愈出院，3例并发瘫痪及1例频繁抽搐患儿好转出院。结论2010年重症手足口病病原以CoxAl6为主，EV71次之。临床上对于持续高热、头痛（年长儿）、呕吐、四肢抖动、颈抵抗、膝反射亢进等患儿要高度重视，并发中枢神经系统感染者病情进展快，早期发现，早期诊断、早期抢救治疗，防止神经源性肺水肿、脑干脑炎的发生，是最大限度降低手足口病病死率、致残率的关键。

Objective To investigate the pathogens and summarize the clinical experiences of severe hand-foot and mouth disease （HFMD）. Methods Seven hundred and eighty-two cases （59.97%） of sever HFMD（complicating with encephalitis） among the 1304 cases of HFMD admitted in our hospital from January 2010 to December 2010 were entrolled in this study. The clinical features, prognosis, treatment and pathogens of children with severe HFMD were retrospectively analyzed. Results Amplification by semi-nested RT-PCR（snRT-PCR） and sequence analysis were done, the genomic RNA was extracted from stool specimens from 754 cases, 565 cases（74.93% ） x^ere positive, 124 cases were negative, 45 cases were not homologym. Amongst the positive samples, the predominant isolated was CoxA16（54. 16% ） , the second was EV71 （38.94%）. By positive treatment, 775 among the 782 cases were cured and left hospital, 3 cases of acute flaccid paralysis and 1 case of frequent convulsions had im- prove and discharged from hospital, but 3 cases died of neurogenic pulmonary edema. Conclusions HFMD is a common intestinal infectious diseases in pediatrics, the main pathogen of severe HFMD were CoxA16, and the second was EVT1. Clinical doctors should pay more attention to the cases of continuous fever, headache, vomiting, extremities tremble, neck resistance, and to observe condition closely for the children complicated with central nervous system infection during clinical therapy. Early diagnosis, early treatment and prevention of pulmonary edema and brainstem encephalitis is the key to minimize the fatali- ty rate and disability rate of severe HFMD.