手足口病合并肺炎支原体感染临床特征分析

Clinical features of hand-foot-mouth disease and co-infection with mycoplasma pneumoniae

目的：分析手足口病（hand-foot-mouth disease，HFMD）合并肺炎支原体感染患儿的临床特征，为控制及有效治疗HFMD提供临床依据。方法收集整理2012年1月至7月HFMD住院患儿详尽的临床资料893例，应用回顾性流行病学方法进行统计分析。结果893例HFMD患儿中，249例合并肺炎支原体IgM阳性，102例（41.0%）为HFMD普通病例，147例（59.0%）为重症病例；644例HFMD肺炎支原体IgM阴性，463例（71.9%）为HFMD普通病例，181例（28.1%）为重症病例。249例合并肺炎支原体感染组年龄分布3～6岁78例（31.3%），母乳喂养151例（60.6%），人工喂养98例（39.4%）；126例（50.6%）最高体温超过39℃，209例（83.9%）热程大于3 d，152例（61.0%）病程大于10 d，138例（55.4%）呕吐，104例（41.8%）嗜睡，196例（78.7%）反复易惊，151例（60.6%）频繁肢体抖动，8例（3.2%）呼吸困难，147例（59.0%）病理征阳性，158例（63.5%）EV71阳性，与肺炎支原体阴性组比较，有统计学意义（P＜0.05）。结论 HFMD重叠肺炎支原体感染与疾病进一步加重有关，建议早期监测是否合并肺炎支原体感染，积极予以抗支原体感染治疗，以缓解临床症状，提高临床治愈率。

Objective To retrospectively analyse the clinical characteristics of children with hand-foot-mouth disease （HFMD） and co-infection Mycoplasma pneumoniae and lay the foundation for better HFMD control and treatment. Methods Clinical data of 893 children with HFMD admitted to the Second Affiliated Hospital of Medical College, Xi＆#39;an Jiaotong University and Xi＆#39;an Children＆#39;s Hospital from January to July 2012 were elaborately collected. Clinical manifestations were summarized and analyzed in this retrospective analysis. Results Of the total 893 cases, 249（27.9%） HFMD cases were Mycoplasma pneumoniae co-infection including 102（41.0%） mild cases and 147（59.0%） severe cases. 644（72.1%） HFMD cases were not Mycoplasma pneumoniae co-infection, including 463（71.9%） mild cases and 181（28.1%） severe cases. Of these patients with Mycoplasma pneumoniae co-infection, 31.3% cases were 3-6 years old, 151（60.6%） presented breastfeeding, and 98（39.4%） presented non breastfeeding. Clinical manifestation among the cases with Mycoplasma pneumoniae co-infection showed that high fever（50.6%）, long duration of fever（83.9%）, long-term course of disease（61.0%）, vomiting （55.4%）, hypersomnia（41.8%）, frequent hyperarousal（78.7%）, limb shaking（60.6%）, dyspnoea（3.2%）, pathologic reflexes（59.0%）, and EV71 positive（63.5%） rates were significantly higher than among the cases without Mycoplasma pneumoniae co-infection. Conclusion Mycoplasma pneumoniae infections should be routinely screened in children with HFMD not only for predicting the disease severity but also for treatment of concomitant mycoplasma infections which will help to relieve symptoms and cure HFMD.