3种不同柯萨奇病毒所致手足口病的临床特征分析

Analysis of clinical characteristics of three different coxsackie virus induced hand,foot and mouth disease

目的比较3种不同柯萨奇病毒(coxsackievirus,CV)CV-A6、CV-A10、CV-A16型引起的手足口病(hand,foot and mouth disease,HFMD)的临床表现,为继续探讨不同肠道病毒所引起HFMD的临床特征提供依据,同时也为HFMD的预防控制工作提供病原学依据。方法收集2018年1月1日至2019年12月31日在泰安市妇幼保健院感染科确诊HFMD的病例信息,根据病原核酸检测结果,分为CA6、CA10、CA16组,采用SPSS18.0软件对3组的临床特征及资料进行统计分析。结果CA6组284例,CA10组51例,CA16组351例。3组性别构成比差异无统计学意义(χ^(2)=1.672,P=0.436);临床分型比较,差异无统计学意义,均以轻型为主;但3组间年龄分布差异有统计学意义,主要高发于3岁以下儿童;3组临床表现比较,CA10组的发热率、神经系统受累表现较高,CA6组多部位皮疹及多形态皮疹和脱甲并发症的发生率最高,CA16组出现消化系统、呼吸系统伴随症状的发生率最高,差异均有统计学意义(P<0.05);3组辅助检查比较,CA16组白细胞和CRP升高发生率均明显低于CA10组和CA6组,差异有统计学意义,3组脑电图慢波比较,差异有统计学意义(χ^(2)=6.287,P=0.043),但在心肌酶谱和肝功酶谱异常、胸片渗出的比较,差异均无统计学意义(P>0.05)。结论CV-A6、CV-A10、CV-A16型HFMD各有不同的临床特征,CV-A10型HFMD可能更易出现重型病例,可供临床医生参考。

Objective:To compare the clinical manifestations of hand,foot and mouth disease(HFMD)caused by three different types of Coxsackievirus(CV)cV-A6,CV-A10 and CV-A16,so as to further explore the clinical features of HFMD caused by different enteroviruses,and to provide scientific basis for future prevention and control strategies of HFMD.Methods:Retrospective investigation was conducted to collect the information of HFMD cases confirmed in the infectious department of our hospital from 2018 to 2019.The eligible cases were divided into CA6,CA10 and CA16 groups according to the results of the nucleic acid test,and the clinical characteristics of the three groups were analyzed and compared.Results:There were 284 cases in CA6 group,51 cases in CA10 group,and 351 cases in CA16 group.The gender composition of the 3 groups was not statistically significant(χ^(2)=1.672,P=0.436).In comparison of clinical manifestations,the fever rate in CA10 group(94.12%)was slightly higher than that in CA6 group,but the fever rates in both groups were significantly higher than that in CA16 group,and the difference between the three groups was statistically significant(χ^(2)=55.483,P<0.001).The CA6 group had the highest incidence of multisite rash and polymorphic rash,and the difference of polymorphic rash between the three groups was statistically significant(χ^(2)=40.658,P<0.001).The CA16 group had the highest incidence of accompanying symptoms of digestive system and respiratory system,while the CA6group and CA10 group had basically the same incidence of nervous system involvement.The comparison of accompanying symptoms of respiratory system and nervous system among the three groups was statistically significant(P<0.05).The rate of decapitation in CA6 group(17.63%)was significantly higher than that in CA10 group and CA16 group,and the comparison between the three groups was statistically significant(χ^(2)=34.549,P<0.001).During the comparison of auxiliary examinations,the incidences of increased leucocyte and CRP in CA16 group were significantly lower than those in CA10 group and CA6 group,and the difference of increased leucocyte and CRP among the three groups was statistically significant(P<0.05).There were statistically significant differences between the three groups in slow EEG(χ^(2)=6.287,P=0.043),but there were no statistically significant differences in myocardial enzyme spectrum,liver enzyme spectrum abnormality or chest radiograph exudation P>0.05).Conclusion:Three types of HFMD,CV-A6,CV-A10 and CV-A16,are found to have different clinical characteristics,and HFMD of CV-A10 is found to be more prone to severe cases,which can be a reference for clinicians.