肠道病毒71型与非肠道病毒71感染所致的合并神经系统损害手足口病的对比分析

Comparison between enterovirus 71-induced and non-enterovirus 71-induced hand,foot and mouth disease complicated with nervous system damage

目的比较肠道病毒71型(EV71)与非EV71感染所致的合并有神经系统损害手足口病(HFMD)患儿的临床特征、实验室检查结果及细胞因子水平。方法选择合并有神经系统损害的HFMD患儿共126例,总结其临床表现,并根据病原学检测结果分为EV71感染组和非EV71感染组,比较两组患者的临床特征、实验室检查结果及细胞因子水平。结果126例患儿均出现皮疹及精神萎靡,其次以发热(92.06%)常见,部分患儿存在易惊、肢体抖动、恶心呕吐、嗜睡、呼吸节律不齐、抽搐、肌无力、颅神经麻痹。两组患儿年龄、性别、合并肺炎及死亡情况、发病至入院天数、发病至神经系统受累天数、发热天数、发热最高体温以及入院时心率、呼吸频次、平均动脉压比较,差异均无统计学意义(P>0.05)。EV71感染组的乳酸脱氢酶、白细胞介素(IL)-2、IL-6及IFN-γ水平均高于非EV71感染组(P<0.05)。结论在合并神经系统损害的HFMD患儿中,EV71阳性率较高,EV71感染者比非EV71感染者更容易出现组织细胞损坏和细胞因子水平的变化。

Objective To compare the clinical characteristics, laboratory parameters and cytokines levels of children with hand, foot and mouth disease（HFMD） complicated with nervous system damage between enterovirus 71（EV71 ） infection and non-EV71 infection. Methods A total of 126 children with HFMD complicated with nervous system damage were enrolled. The clinical manifestations of all children were summarized. The children were divided into EV71 infection group and non-EV71 infection group according to the pathogen examination result. The clinical characteristics,laboratory parameters and cytokines levels were compared between the two groups. Results Skin rashes and listlessness were found in 126 cases, and fever was the second common syndrome （92.06%）. Sartle, limb shaking, nausea, vomiting, lethargy,irregular respiratory rhythm, convulsions, myasthenia and cranial nerve palsies existed in some cases. There was no significant difference in the age, gender, complication with pneumonia, death, duration from onset to hospitalization, duration from onset to nervous system involvement, duration of fever, the maximum temperature of fever onset, or HR,respiratory frequency and mean arterial pressure on admission between the two groups（ P 〉 0.05 ）. The levels of lactate dehydrogenase, interleukin （IL）-2, IL-6 and interferon-γin the EV71 infection group were higher than the levels in the non-EV71 infection group（P 〈 0.05 ）. Conclusion The rate of EV71 infection is quite higher in the HFMD children complicated with nervous system damage. The children with EV 71 infection are prone to cell and tissue injury and variation of cytokines levels compared with the children with non-EV71 infection.