重症手足口病病原学与临床特征及实验室指标的关系研究  

Etiology,clinical characteristics,and laboratory results in patients with severe hand,foot,and mouth disease

作　　者：隋美丽[1] 张超[1] 黄学勇[2] 李懿[2] 杨海燕[1] 李幸乐[2] 杜燕华[2] 卫海燕[2] 申晓靖[2] 冯慧芬[3] 秦新华[4] 任静朝[5] 郗园林[1] 段广才[1,6] 

机构地区：[1]郑州大学公共卫生学院,河南郑州450001 [2]河南省疾病预防控制中心,河南郑州450016 [3]郑州大学第五附属医院,河南郑州450052 [4]郑州市儿童医院,河南郑州450053 [5]新乡医学院公共卫生学院,河南新乡453003 [6]河南省分子诊断与医学检验技术协同创新中心(新乡医学院),河南新乡453003

出　　处：《中国病原生物学杂志》2015年第6期481-486,共6页Journal of Pathogen Biology

基　　金：国家自然科学基金项目(No.81172740);国家自然科学基金项目(No.81473030);河南省高等学校重点科研项目(No.15A330003)

摘　　要：目的探讨重症手足口病患儿的病原分类及不同病原引起的手足口病临床特征和实验室指标差异,为手足口病的诊疗和防控提供依据。方法收集2013年4~5月郑州市某哨点医院确诊的手足口病重症患儿的粪便标本,采用实时荧光定量RT-PCR对其进行病原学分型,同时收集患儿基本信息和临床资料,分析重症手足口病的主要病原及常见病原引起的手足口病临床特征及实验室检查特点。结果 1）EV71、其他EV及CoxA16病毒为重症手足口病患儿的主要病原体;2）临床特征（年龄、性别、体重、体温、脉搏、收缩压、舒张压、血糖、肢体抖动）中,除体重及肢体抖动发生率3组间差异有统计学意义（P〈0.05）外,其余特征3组间差异均无统计学意义（P〉0.05）;两两比较显示其他EV组患儿体重较高,EV71组患儿肢体抖动比例较高;3）NEUT、LYMPH、MONO、EO、BASO百分率,T细胞,Th细胞,NK细胞,IgA,C3,C4,NSE,PCT,TNT-HS,TBIL,IBIL,ADA,PA,GLO及CK水平在EV71、CoxA16及其他EV阳性组重症手足口病患儿差异均有统计学意义（P〈0.05）。两两比较显示其他EV组与EV71、CoxA16组相比NEUT百分率较高,LYMPH百分率较低（P〈0.05）,而MONO百分率在CoxA16组的水平较高（P〈0.05）;EV71组EO百分率较高（P〈0.05）;其他EV阳性组与EV71、CoxA16组相比T细胞及Th细胞水平显著下降（P〈0.05）,NK细胞水平显著升高（P〈0.05）;与CoxA16组相比,EV71组和其他EV组IgA、C3、C4及NSE较高（P〈0.05）;与其他两组相比EV组PCT水平较高,而TNT-HS水平较低（P〈0.05）;EV71组与CoxA16及其他EV组相比IBIL和TBIL水平较低而ADA水平较高（P〈0.05）,CoxA16组与EV71及其他EV组相比PA水平较高而GLO水平较低（P〈0.05）;其他EV组CK水平较高（P〈0.05）。结论 1）除EV71外,其他EV及CoxA16引起的手足口病重症病例不容忽视;2）肢体抖动对EV71感染诊断有帮助;3）重症手足口病不仅可累及皮肤、黏膜Objective To explore the differences in the etiologies and their clinical manifestations and laboratory results in patients with severe hand, foot, and mouth disease （HFMD） in order to provide a basis for the treatment and control of HFMD. Methods Quantitative fluorescence real-time PCR was used to classify etiology based on stool samples from patients with severe HFMD in a sentinel hospital in the City of Zhengzhou from April to May 2013. The samples were grouped by nucleic acid results. Patient information and clinical data were collected, the primary pathogens responsible for HFMD were analyzed, and clinical manifestations in and laboratory results from patients with severe HFMD were ana- lyzed. Blood samples were also collected. The following indicators were examined in serology： routine serology （including the white blood cell, red blood cell, and platelet counts, the ratio of neutrophils to lymphocytes, the percentage of lym phocytes, the ratio of monocytes to lymphocytes, the ratio of eosinophils to neutrophils, and the ratio of basophils to lymphocytes）, blood lymphocyte subsets （T ceils, Ts cells, Th cells, Th/Ts, NK cells, and B cells）, immunological factors （immunoglobulin A, immunoglobulin M, immunoglobulin G, complement 3, and complement 4）, markers （neu ron-specific enolase, procalcitonin, S100 protein, and cardiac troponin T）, liver indices （total bilirubin, direct bilirubin, indirect bilirubin, glutamic-pyruvic transaminase, glutamic oxalacetic transaminase, adenosine deaminase, prealbumin, total protein, albumin, and globulin）, and heart indicators （lactic dehydrogenase, alpha hydroxy butyric acid, creatine kinase, and creatine kinase-MB）. Results 1） The main pathogens responsible for severe HFMD were EV71, EV, and CoxA16.2） There were no significant differences in many clinical manifestations （age, sex, body temperature, the num her of peripheral white blood cells, and glucose levels） except for shaking of the limbs and body weight. Pairwise comparison indic

关 键 词：重症手足口病 病原学 临床特征 实验室指标 

分 类 号：R512.5[医药卫生—内科学]