重症手足口病并心肌损伤的临床特征

Clinical Features of Severe Hand-Foot-Mouth Disease Combined with Myocardial Damage in Children

目的探讨手足口病(HFMD)并心肌损伤患儿的临床特征及预后。方法选择2010年4-6月在湖南省儿童医院ICU住院治疗的HFMD重症及危重症患儿为研究对象,了解HFMD患儿心肌损伤的发生率,对其临床特征和辅助检查结果进行总结分析,比较心肌酶学异常组和心肌酶学正常组神经、呼吸和循环系统表现,以及辅助检查结果的差异,明确HFMD并心肌损伤患儿的预后。结果共369例患儿纳入分析,血清CK-MB和(或)心肌肌钙蛋白I(cTnI)升高者247例(66.9%)。心肌酶学异常组(包括cTnI升高组、CK-MB升高组及cTnI、CK-MB均升高组)平均热程,抽搐、肢体瘫痪、意识改变和脑神经受累的发生率,心率增快或减慢、血压异常、毛细血管充盈时间(CRT)>3 s、心力衰竭、呼吸节律改变的发生率及血管活性药物的使用率,CRP及血乳酸升高发生率均显著高于心肌酶学正常组。心肌酶学异常组危重症、神经源性肺水肿和肺出血的发生率及病死率均显著高于心肌酶学正常组。结论 HFMD患儿心肌损伤的发生率高,心肌酶谱、cTnI、CRP及血清乳酸水平的升高提示心肌损伤的发生;心肌酶学异常的HFMD患儿更易出现中枢神经系统受累的表现,病情更严重,预后更差。

Objective To explore the clinical features, incidence and prognosis of children with severe hand - foot - mouth disease （HFMD） combined with myocardial damage. Methods The children with severe HFMD treated in Intensive Care Unit of Hunan Provincial Children＇s Hospital from Apr. to Jun. in 2010 ,were recruited and divided into the abnormal myocardial enzyme group ,with their cardiac tropo- nin - I （cTnl） elevated, MB isoenzyme of creatine kinase （ CK - MB ） elevated and cTnI, CK - MB both elevated ; and the normal myocardial enzyme group. The data related to fever and clinical manifestations of nervous, respiratory and circulatory systems, and the laboratory examina- tions were summarized and analyzed. The differences were analyzed on the clinical manifestation and the laboratory examination between thc 2 groups. Then the prognosis of HFMD with myocardial damage was analyzed. Results There were 247 cases （ 66.7 % ） with the abnormal myo- cardial enzymes out of 369 cases recruited with HFMD. Between the abnormal myocardial enzyme group and the normal myocardial enzymes group,there were significant differences in high fever, convulsion, limb weakness, altered consciousness, cranial nerve involvement, tachycardia, abnormal blood pressure, heart failure, capillary filling time being more than 3 seconds, tachypnea, respiratory rhythm abnormality, use of vasoactive drugs, C - reactive protein and serum lactate. At the same time, neurogenic pulmonary edema and pulmonary hemorrhage and death rate of the children with HFMD in abnormal myocardial enzyme group were significantly higher than those in normal myocardial enzyme group. Conclusions The children with HFMD have a high incidence of myocardial injury and are more vulnerable to involvement of the central nervous system. The elevated levels of myocardial enzymes, cardiac troponin, CRP, and serum lactate in children with HFMD suggest the occurrence of myocardial injury. The children with HFMD combined with myocardial damage are more severe, and their prognosis are much worse.