不同型别肠道病毒感染所致手足口病皮疹特点分析

Characteristic analysis of erythra of HFMD caused by different type of enterovirus

目的 对实验室确诊的手足口病病例的皮疹特点进行分析,总结不同病原所致手足口病皮疹特点,有助于提高临床诊断准确性。方法 对2013年4月—2014年12月疑似或临床诊断手足口病的患儿留取咽拭子标本,采用实时荧光定量聚合酶链反应（Real-Time PCR）方法检测标本中肠道病毒核酸,根据VP1核苷酸序列同源性进行型别鉴定,据病原学诊断结果分为3组（EV71组、CA16组和CA6组）进行皮疹特点分析。结果 ①经病原学确诊并且临床资料完整的病例共809例,EV71组244例,CA16组367例,CA6组198例,年龄3月~12岁。②EV71组咽峡部疱疹发生率最低,CA16组上腭、颊黏膜疱疹发生率最高,CA6组颊黏膜、齿龈、舌部疱疹发生率低,各组间比较差异有统计学意义（PEV71/CA16、PEV71/CA6、PCA16/CA均〈0.05）。③CA6组手背、肘关节、膝关节、前胸、后背皮疹较其他两组多,手心、手指、足趾皮疹较其他两组少,组间差异有统计学意义（PEV71/CA6、PCA16/CA均〈0.01）;CA16组足心、足背皮疹较CA6组较少,组间差异有统计学意义（PCA16/CA6均〈0.05）。④52.9%的患儿（428/809）存在两种形态以上皮疹,CA6组皮疹更具多形性,两种及以上皮疹形态共存病例数与其他两组比较差异有统计学意义（PEV71/CA6、PCA16/CA6均〈0.01）。结论 不同型别肠道病毒感染所致手足口病皮疹特点有所不同,CA6感染所致皮疹更具特征性,尤其在不具备病原检测的条件时,可帮助医生区分肠道病毒型别,判断预后。

Objective To analyze the characteristic of skin erythra of 809 cases of HFMD,laboratory diagnosed from 2013 to 2014 reception in infection department,in order to summary the clinical characteristics of skin erythra caused by different enterovirus,and improve the level of the clinical diagnosis. Methods Throat swabs were collected from children with HFMD or suspected,then Quantitative Real-time PCR was performed to detect enterovirus nucleic acid,identify the virus type by VP1 nucleotide sequence homology,analyze the rash characteristic of three groups（ EV71,C6,and CA6）,divided according to results of etiology. Results ①Among 809 cases with complete clinical data and identified pathogen,244 in EV71,367 in CA16,and 198 in CA6 group,the age from these cases ranged from 3 month to 12 years old. ②The cases in group EV71 showed less herpes of mouth in isthmus,and more in palate and buccal mucosa of the group CA16,and less in palate,isthmus and buccal mucosa of the group CA6,all the statistical significance was prominent（ PEV71 / CA16,PEV71 / CA6,PCA16 / CA 0. 05） .③The skin erythra of three groups were mainly distributed to palm pelma and hip,the cases in group CA6 showed more herpes in hand back,chest,back,elbow and knee than other two groups,and showed less herpes in Palm fingers and toes（ PEV71 / CA6,PCA16 / CA 0. 01）; the cases in group CA16 showed less herpes in pelma and sole center than that in group CA6,the statistical significance was prominent（ PCA16 / CA6 0. 05）. ④Two more forms of skin erythracan were seen at 52. 9% of all cases,the cases in group CA6 show more form of skin erythra,more than other two groups,and the statistical significance was prominent（ PEV71 / CA6,PCA16 / CA6 0. 01）. Conclusion The HDMF caused by different type of enterovirus,show different skin erythra,and most Characteristic in CA6. It can help doctors to distinguish the type of intestinal virus,especially in the condition of no examination of pathogen.