399例重症手足口病的实验室检查及临床特征分析

The laboratory tests and clinical characteristics of 399 cases with severe hand,foot and mouth disease

目的比较肠道病毒71型(EV71)感染与其他肠道病毒感染的重症手足口病(HFMD)的实验室检查和临床特征的区别。方法选择2010年5月～2011年9月于本院住院的重症HFMD患者共399例。采用荧光PCR法检测EV71,按EV71RNA是否阳性,将患者分为EV71感染组和其他EV感染组,比较两组患者的年龄、性别、发病至入院天数、是否伴神经系统受累、发病至神经系统受累天数、发热天数、发病至入院的最高体温、是否需入住ICU治疗、住院天数和转归、入院时心率、呼吸频率和平均动脉压,并比较两组患者入院时主要的实验室检查结果。结果 399例重症HFMD患者中EV71(+)者182例(45.6%)。与其他EV感染组相比,EV71感染组患者发热天数更长、入院时平均动脉压、肌酸激酶水平、血糖水平、入住ICU比例(17.6%)和病死率(4.9%)均显著增加,且差异具有统计学意义(P<0.05)。结论 EV71为重症HFMD患者常见的病原体,EV71感染所致的重症HFMD患者病情更重,预后更差。

Objective To compare the laboratory parameters and clinical characteristics of severe hand, foot and mouth disease （HFMD） between patients with enterovirus 71 （EV71） infection and non-EV71 enterovirus infection. Methods Total of 399 patients with severe HFMD were enrolled from May 2010 to September 2011. Ribonucleic acid （RNA） of E^71 and Coxsackie virus group A16 （CoxA16） were detected by real-time fluorescence quantitative PCR from the samples of throat swab, respectively. According to whether EV71 RNA was positive, the patients were divided into two groups including the EVT1 infection group and non-EV71 enterovirus infection group. The age, gender, days of onset to admission, whether the nervous system involved, days of the nervous system involvement, days of fever, the maximum temperature from onset to admission, whether requiring admission to ICU for further treatment, days of hospitalization, clinical outcome, vital signs and laboratory detection at admission were compared between the two groups. Results Total of 182 cases （45.6%） were EV71 RNA positive among the 399 hospitalized patients. Compared with the non-EV71 infection group, the EV71 infection group had significantly longer days of fever, higher levels of mean artery pressure （MAP） , creatine kinase （CK） and blood glucose （ GLu）, higher proportion of admission to ICU （17.6%） and mortality （4.9%）. Conclusions EV71 was the common pathogen of severe HFMD. Severe HFMD caused by EV71 infection had much more severe conditions and worse prognosis.