重症手足口患儿病原学与临床特征的关系研究

A study of the relationship between etiology and clinical features of children with severe hand，foot，and mouth disease

摘要:

目的：分析不同肠道病毒（enterovirus，EV）引起的重症手足口病在临床特征上的差异，为临床诊疗和防控提供科学依据。方法：选取2016年4月至2017年4月在重庆医科大学附属儿童医院住院治疗并确诊为重症手足口病的患儿421例，应用实时荧光定量PCR（quantitative real-time PCR，RT-PCR）检测肠道病毒。排除13例病毒检测不明确的患儿，最终纳入研究408例，根据感染病毒不同将其分为EV71组、非EV71组和EV阴性组，比较各组间在临床特征上的差异。结果：408例患儿中EV71阳性137例（33.59%）、 非EV71阳性212例（51.96%）、EV阴性59例（14.46%）。EV71组的发热时间较非EV71组（P=0.000）和EV阴性组（P=0.017）更长，且EV71组发生手足抖动（P=0.002）和头痛（P=0.003）的比例大于非EV71组。非EV71组在口（P=0.003）、四肢（P=0.001）、躯干（P=0.006）上的皮疹发生率明显多于EV71组，但非EV71组皮疹持续时间较EV71组（P=0.000）和EV阴性组（P=0.015）短。结论：EV71型重症手足口病在发热，神经受累的症状比其他组更严重，而非EV71型在皮疹的分布部位上更为广泛，但皮疹持续时间更短。

Abstract:

Objective：To analyze the differences in clinical features of severe hand，foot，and mouth disease caused by different en－teroviruses（EV），and to provide scientific evidence for its clinical diagnosis，treatment，and prevention. Methods：A total of 421 children admitted and diagnosed with severe hand，foot，and mouth disease in Children’s Hospital of Chongqing Medical University from April 2016 to April 2017 were selected，and quantitative real-time PCR was used to detect EV. Excluding 13 children with unclear re－sults，408 children were included in the final study. According to EV strains，the children were divided into EV71 group，non-EV71 group，and EV-negative group to compare their clinical features. Results：Among the 408 children，137（33.59%） were positive for EV71，212（51.96%） were positive for non-EV71，and 59（14.46%） were negative for EV. The EV71 group had a significantly longer duration of fever than the non-EV71 group（P=0.000） and the EV-negative group（P=0.017），and had a significantly higher inci－dence of limb tremor（P=0.002） and headache（P=0.003） than the non-EV71 group. The non-EV71 group had a significantly higher incidence of skin rash on the mouth（P=0.003），limbs（P=0.001），and trunk（P=0.006） than the EV71 group，but had a significantly shorter duration of skin rash than the EV71 group（P=0.000） and EV negative group（P=0.015）. Conclusion：Patients with severe hand，foot，and mouth disease caused by EV71 have more severe symptoms of fever and neurological involvement than other groups，while those caused by non-EV71 have a wider distribution but a shorter duration of rashes.