1381例手足口病患者的流行病学及临床特征分析  

Analysis on clinical features of 1381 cases with hand-foot-mouth disease

作　　者：党双锁[1,2] 邓慧玲[3] 李亚萍[1] 王文俊[1] 贾晓黎[1] 高宁[1] 李梅[1] 封婷[1] 

机构地区：[1]西安交通大学医学院第二附属医院感染科,西安市710004 [2]西安交通大学医学院流行病与卫生统计学科 [3]西安市儿童医院感染科

出　　处：《中华实验和临床感染病杂志（电子版）》2013年第4期20-23,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：2012西安交通大学第二附属医院院基金[No.RC(GG)201207]

摘　　要：目的分析西安市2011年1381例手足口病的流行病学特征及263例重型手足口病患儿的临床特点,为控制及有效治疗手足口病提供科学依据。方法收集整理2011年西安市手足口病诊疗定点医院的病例资料,应用描述性方法进行流行病学分析;同时对263例重型手足口病患儿的一般资料、症状、体征、辅助检查以及转归进行回顾性分析。结果 1381例手足口病患儿中普通病例1088例(78.8%),重型病例为263例(19.0%),危重型病例为30例(2.2%),其中死亡3例(0.2%)。1381例手足口病患儿中男性860例,女性521例,男女比为1.65︰1。2011年西安市全年各月均有病例报告,以5～6月份和8～11月份发病例数较多,占全年的69.6%。手足口病患儿年龄分布以小年龄组为主,5岁以下儿童占全部病例的96.7%。1381例病例标本,检出EV71阳性859例,占病例数的62.2%。263例重型病例主要以EV71感染为主,占76.8%。30例危重型病例EV71阳性占90.0%。死亡病例全部为EV71型。263例重型病例中,均伴有皮疹,反复易惊、频繁肢体抖动、嗜睡等早期脑炎表现,50例(19.0%)患儿出现惊厥、抽搐表现,243例(92.4%)患儿出现病理征阳性;256例(97.3%)患儿出现发热,其中139例(52.9%)患儿最高体温波动于38.1～39.0℃,83例(31.6%)最高体温大于39.0℃,168例(63.9%)患儿白细胞显著升高,138例(52.5%)患儿血糖显著升高,168例(63.9%)患儿合并呼吸道病毒感染,其中以流感病毒及合胞病毒感染为主。结论西安市2011年手足口病疫情的发生有明显的性别、年龄、季节及地区等差异。反复易惊、频繁肢体抖动、嗜睡、高热、白细胞升高、血糖高及合并呼吸道病毒感染等临床特征是重型手足口病的警示信号,应该早期发现和干预。Objective To study the clinical features of children with hand-foot-mouth disease （HFMD） and investigate better approaches for HFMD prevention and treatment. Methods Clinical data of 1381 children with HFMD admitted to the Second Afifliated Hospital of Medical College, Xi’an Jiaotong University and Xi’an Children’s Hospital from January to December 2011 were collected, retrospectively. Clinical data and laboratory data were summarized for 263 severe cases. Results HFMD cases were reported in each month, while the majority （69.6%） were reported from May to June and from August to November. 96.7%of the cases were less than 5 years old. More boys than girls were reported （male/female：1.65/1）. 62.2%of the cases were human enterovirus 71 （EV71） positive. Among the 1381 cases, 263 （19.0%） suffered severe HFMD, 30 （2.2%） suffered critical HFMD, and 3 （0.2%） died. The EV71 positive rates were 76.8%, 90.0%and 100%, respectively. All the 263 cases with severe HFMD presented rash and early symptoms of encephalitis such as frequent hyperarousal, limb tremor and somnolence. Of these patients, 50 （19.0%） presented convulsion and seizure, 243 （92.4%） patients presented pathologic relfexes, 256 （97.3%） patients presented fever, 139 （52.9%） had moderate temperature （38.1-39.0℃）, 83 （31.6%） patients had high temperature （〉 39.0℃）, 168 （63.9%） patients had signiifcant increased white blood cell （WBC） count, 138 （52.5%） patients had signiifcant increased blood glucose level, and 168 （63.9%） patients were co-infected with respiratory virus such as inlfuenza virus and syncytial virus. Conclusions The occurrence of HFMD was different among seasons, regions, sexes and ages in 2011 in Xi’an. Frequent hyperarousal, limb tremor, somnolence, high counts of WBC, high levels of blood glucose, and co-infection with respiratory tract viruses were the early signs of severe HFMD, and should be identiifed in time for early intervention.

关 键 词：手足口病 流行特征 临床特征 肠道病毒71型 

分 类 号：R725.1[医药卫生—儿科]