手足口病对婴幼儿喘息的影响

Investigation of infants/toddlers wheezing affected by the hand foot and mouth disease

目的探讨婴幼儿喘息严重度与手足口病（HFMD）感染的关系。方法选取2010年1月至2012年1月本院呼吸科有建档资料的婴幼儿喘息合并HFMD的病例，依据HFMD感染病原，分为肠道病毒71型（EV71组）30例，柯萨奇病毒A组16型（CA16组）30例为对照组；按喘息严重度将病例分为间歇状态和轻度持续组（A组）、中度持续和重度持续组（B组），按HFMD严重度分为普通病例组、重症病例组。对EV71、CA16两组病例在HFMD前后喘息严重度、HFMD严重度与喘息严重度的关系、血清细胞因子γ干扰素（IFN-γ）、白细胞介素4（IL-4）的含量在不同组间进行比较。结果（1）HFMD前后喘息严重度（A组、B组）的对应病例为：EV71组（25例、5例）、（5例、25例），CA16组（24例、6例）、（15例、15例），病例构成比EV71及CA16相同组感染前后比较，差异均有统计学意义（P〈0．05）；EV71组与CA16组比较感染前差异无统计学意义（X^2=0．11，P〉0．05）；感染后差异有统计学意义（X^2=7．50，P〈0．05）。（2）重症病例组、普通病例组与喘息严重度（A组、B组）对应病例为：感染前（17例、1例）、（32例、10例），感染后（2例、16例）、（18例、24例），比较重症病例组和普通病例组感染后喘息严重度升级病例构成比，差异有统计学意义（X^2=5．88，P〈0．05）。（3）血清细胞因子IFN-γ／、IL-4的含量、IFN-γ/IL-4比值，EV71及CA16相同组感染前后比较，差异均有统计学意义（P〈0．001）；EV71组与CA16组比较感染前差异无统计学意义（P〉0．05）；感染后差异有统计学意义（P〈0．05）。结论婴幼儿喘息合并HFMD，重症病例及EVT1感染病例的喘息严重度在感染后短期内有加剧趋势；EV71感染可能促进Th1／Th2漂移现象。

Objective To investigate the relationship between the severity of infant/toddlers wheezing and hand, foot and mouth disease （HFMD） infection. Methods We selected infant/toddlers wheezing with HFMD cases in respiratory department of our hospital from January 2010 to January 2012, and 30 cases of en-terovirus 71 （ EV71 ） were selected as the experimental group and 30 cases of coxsackie virus A type 16（CA16） as the control group,respectively,according to HFMD pathogen infection. Wheezing cases by severity were di-vided into intermittent status with mild persistent group （A） and moderate and severe persistent group （ B ）. HFMD by severity were divided into ordinary and severe cases group. Wheezing severity before and after HFMD,relationship between HFMD severity and wheezing severity and the content of serum cytokines such as interferon-γ/（IFN-γ） and interleukin-4 （IL-4） were compared between EV71 group and CA16 group,and statisti-cal analysis was performed. Results （1） Wheezing severity（A,B） corresponding cases：EV71 group（25,5）, （5,25） ,and CA16 group（24,6）, （15,15） before and after HFMD. The case-constituent ratio in EV71 and CA16 same group was compared before and after infection,and the differences were statistically significant（ P 〈 0. 05 ）. The differences in EV71 group and CA16 group were not statistically significant （ X^2 = 0. 11, P 〉 0. 05 ） before infection, and were statistically significant （X^2 = 7.50, P 〈 0. 05 ） after infection. （2） Severe cases, ordina-ry group and severe wheezing（A,B） corresponding cases：（17,1） ,（32,10） before infection,and（2,16） ,（18, 24） after infection. The upgrade cases constituent ratio of wheezing severity after infection were compared be-tween severe and ordinary cases group, and the difference was statistically significant （X^2 = 5.88, P 〈 0. 05 ）. （3） The content of serum cytokines as IFN-γ/and IL-4 and IFN-γ/IL-4 ratio were compared in EV71 group and CA16 group before and after infection, and the differences were statistically significant（ P 〈 0. 001 ） ; and the differences compared in EV71 group and CA16 group were not statistically significant（ P 〉 0. 05 ） before infec-tion and statistically significant（P 〈 0. 05 ） after infection. Conclusions Infant/toddlers wheezing with HFMD and wheezing severity of severe disease and EV71 infections were exacerbated trend in the short term after infec-tion. The infection of EV71 may promote Thl/Th2 drift.