手足口病合并细菌感染的临床特征与免疫功能变化研究  

Clinical characteristics of hand,foot,and mouth disease complicated with bacterial infections and change of immune function

作　　者：汤昔康[1] 李庆彦[2] 李汝霞[3] 刘春华[2] 刘晶晶[2] 

机构地区：[1]中山大学孙逸仙纪念医院儿科,广东广州510120 [2]聊城市人民医院感染科,山东聊城252000 [3]中山大学附属第三医院急诊科,广东广州510630

出　　处：《中华医院感染学杂志》2016年第20期4721-4723,4762,共4页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目(2015ZRA15049)

摘　　要：目的探讨手足口病合并细菌感染患儿的临床特征及免疫功能改变,为临床治疗提供相关依据及有效的防治措施。方法选取2013年1月-2015年10月住院104例手足口病患儿为研究对象,按感染类型不同分为合并细菌感染组28例,单纯病毒感染组76例。比较两组患儿临床症状、实验室数据(WBC、CRP、PCT、Glu、CKMB、ALT)、体液免疫水平(IgG、IgA、IgM)及细胞免疫水平(CD3^+、CD4^+、CD8^+、CD19^+)及预后。结果与单纯病毒感染组相比,合并细菌感染组在重症人数、热程、惊跳、呕吐、嗜睡发生率上差异有统计学意义(P<0.05);在热峰、皮疹、抽搐、肺出血发生率及EV71检出率、死亡率差异无统计学意义;合并细菌感染组其PCT、Glu、CKMB、ALT水平更高(P<0.05),而WBC、CRP差异无统计学意义;合并细菌感染组CD_3^+、CD_4^+、CD_8^+水平较低,CD_(19)^+、IgA、IgM水平较高(P<0.05)。结论手足口病合并细菌感染后临床表现加重,可能与细胞、体液免疫紊乱进一步加重有关,PCT在鉴别合并细菌感染上具有优势。可通过监测PCT早期发现细菌感染,给予积极治疗,防止病情恶化。OBJECTIVE To explore the clinical characteristics of the hand, foot, and mouth disease children compli- cated with bacterial infections and observe the change of immune function so as to provide guidance for clinical treatment and put forward the effective prevention measures. METHODS A total of 104 children with hand, foot, and mouth disease who were hospitalized from Jan 2013 to Oct 2015 were recruited as the study objects and divided into the complicated bacterial infection group with 28 cases and the single viral infection group with 76 cases ac- cording to the type of infection. The clinical symptoms, laboratory data （WBC, CRP, PCT, Glu, CK-MB, and ALT）,humoral immunity levels（IgG, IgA, IgM）, cellular immunity levels （CD3 ＋ , CD4 ＋ , CD8 ＋ ,CD19 ＋ ） , and outcomes were observed and compared between the two groups of children. RESULTS There was significant differ- ence in the number of severe cases, duration of fever, or incidence rate of frequent hyperarousal ,vomiting, or hy- persomnia between the single viral infection group and the complicated bacterial infection group （P〈0.05） ; there was no significant difference in the incidence rate of fever peak, rash, cramp, pulmonary hemorrhage, detection rate of EV71, or mortality rate; the levels of PCT, Glu, CK-MB, and ALT were higher in the complicated bacte- rial infection group than in the single viral infection group （P〈0.05）; however, there was no significant differ- ence in the WBC or CRP. The levels of CD3 ＋ , CD4 ＋ , and CDs ＋ were lower in the complicated bacterial infection group than those in the single viral infection group; the levels of CD19 ＋ , IgA, and IgM were higher in the compli- cated bacterial infection group than those in the single viral infection group （P 〈 0. 05 ）. CONCLUSION The clinical manifestations of the children with hand, foot, and mouth disease aggravated after they are complicated with bac- terial infections, which may be related to the further aggravation of disorder of cellular, h

关 键 词：手足口病 细菌 临床特征 免疫功能 

分 类 号：R512.5[医药卫生—内科学]