非典型手足口病临床特点与不同病毒血清型的相关性分析

The clinical characteristics of children with atypical HFMD and the involvement of the different enterovirus serotypes associated

目的探讨非典型手足口病临床特点及与不同病毒血清型的相关性。方法回顾分析2013年9月~2016年9月本院收治的94例非典型手足口病患儿临床资料。依病症分布特点,将患者分为肢端组(病变主要分布在肢端)、扩散组(病变扩散至躯干)和皮疹组(皮肤形态病变)。Mann-Whitney检验非参数据,Fisher精确检验组间差异。结果 94例患儿中位月龄22个月(4~84个月),均检测病毒基因分型,柯萨奇病毒A16基因型检出率81.91%(77/94例)。所有患儿中15%为扩散形式,62%为肢端形式且多为2岁以下患儿,23%为柯萨奇皮疹形式且年龄在2岁以上者居多。大多数患儿出现中度到重度的皮肤水泡疹,80%的患儿出现掌跖臀部紫癜。根据发病时间,非典型手足口病以春、秋季为高发期。结论非典型手足口病发病具有明显的季节性,多发于低龄儿,病原分析进一步发现柯萨奇病毒A16与非典型病症存在显著相关性。临床需要扩大护理范围,尤其是真皮外层症状治疗,必要时住院治疗防止并发症。

Objective To explore the atypical clinical characteristics of children with hand,foot and mouth disease and the correlation of different intestinal virus serotype.Methods The clinical data of 94 children with atypical hand,foot and mouth disease were analyzed.The patients included acra group（lesions mainly distributed in acromegaly）,diffusion group（disease spread to the trunk）,and coxsackie eczema group（eczema lesions）.Mann Whitney nonparametric test data and Fisher＇s exact test were analyzed.Results 94 patients were detected with all the genotyping of the virus.The constituent ratio of acra group,diffusion group and coxsackie eczema group was 62%,15% and 23%.80% of the patients were with palmoplantar purpura.Coxsackievirus A6 genotype detection rate was 81.91%（77/97）.According to the date of onset,atypical HFMD common occurred in spring and autumn.Conclusion Our prospective study shows that the identification of atypical foot and mouth disease has obvious seasonal,multiple leptospirae,pathogenic analysis further found CA6 and atypical symptoms exist significant correlation.Clinical care of these patients should include symptomatic treatment of extracutaneous features and,if necessary,hospitalization for complications.