200例手足口病患儿临床表现及其实验室诊断  

Clinical manifestations of 200 children with hand-foot-mouth disease and its laboratory diagnosis

作　　者：杨世明[1] 丁莉[1] 沈瑛[1] 何津云 李明[3] 朱静[1] 申恩瑞 张维[1] 张开明[1] 李淑娴 YANG Shi-ming;DING Li;SHEN Ying;HE Jin-yun;LI Ming;ZHU Jing;SHEN En-rui;ZHANG Wei;ZHANG Kai-ming;LI Shu-xian(Jianshui County People's Hospital,Honghe,Yunnan 654399,China)

机构地区：[1]云南省红河州建水县人民医院儿科,云南红河州654399 [2]云南省红河州建水县中医院儿科,云南红河州654399 [3]昆明医科大学附属儿童医院儿科,云南昆明650034

出　　处：《中华医院感染学杂志》2021年第2期291-295,共5页Chinese Journal of Nosocomiology

基　　金：云南省科研基金资助项目(2016NI046)。

摘　　要：目的分析柯萨奇病毒A组6型(CoxA6)、柯萨奇病毒A组10型(CoxA10)及肠道病毒A71型(EV71)感染致手足口病(HFMD)患儿临床症状及血清淀粉样蛋白A(SAA)、降钙素原(PCT)、C-反应蛋白(CRP)检测的鉴别价值。方法选择2017年1月-2019年6月云南省红河州建水县人民医院确诊为CoxA6、CoxA10及EV71型HFMD患儿200例为研究对象,比较其临床症状及血清SAA、PCT、CRP水平;绘制受试者工作特征曲线(ROC)分析SAA、PCT、CRP指标鉴别诊断HFMD的临床价值。结果 200例HFMD患儿中,CoxA6(50.50%),CoxA10(27.00%),EV71(22.50%);EV71型HFMD患儿的住院时间、发热持续时间较CoxA6型、CoxA10型延长,惊跳/四肢抖动、呕吐/腹泻、脑炎/脑膜炎、肺水肿、循环衰竭、手掌及足底皮疹、斑丘疹占比显著高于CoxA6、CoxA10型,但口腔及口周皮疹、小腿及前臂皮疹、颈部及躯干皮疹、疱疹、大疱疹占比显著低于CoxA6型、CoxA10型患儿(P<0.05);EV71型HFMD患儿SAA、PCT、CRP水平显著高于CoxA6型、CoxA10型HFMD患儿(P<0.05);ROC曲线分析结果SAA以426.44mg/L为临界值,鉴别EV71的敏感度、特异度为88.89%、93.55%,且SAA的曲线下面积(AUC)显著高于PCT、CRP(P<0.05)。结论 CoxA6、 CoxA10、EV71型HFMD患儿的临床症状存在一定差异, CoxA6、CoxA10 HFMD患儿神经系统受累症状相对少见,以广泛的、严重皮损更为常见,住院时间更短,SAA可用于CoxA6、 CoxA10及EV71型HFMD的初步鉴别。OBJECTIVE To investigate the clinical symptoms of the children with hand-foot-mouth disease(HFMD) caused by Coxsackie virus A6(CoxA6), Coxsackie virus A10(CoxA10) and enterovirus A71(EV71) infections and analyze the diagnostic value of serum amyloid A(SAA), procalcitonin(PCT) and C-reactive protein(CRP). METHODS A total of 200 children who were diagnosed with CoxA6, CoxA10 and EV71 type HFMD in Jianshui County People′s Hospital from Jan 2017 to Jun 20119 were recruited as the study objects.The clinical symptoms and levels of serum SAA, PCT and CRP were compared, and the receiver operating characteristic(ROC) curve was drawn to analyze the clinical value of SAA, PCT and CRP in diagnosis of HFMD. RESULTS Among the 200 children with HFMD, 50.50% were CoxA6, 27.00% were CoxA10, and 22.50% were EV71.The length of hospital stay and duration of fever of the children with EV17 type HFMD were longer than those of the children with CoxA6 type and Cox A10 type HFMD;the proportions of the children who had startle/trembling limbs, vomiting/diarrhea, encephalitis/meningitis, pulmonary edema, circulation failure, rashes on palm and foot rub and maculopapular rash were significantly higher among the children with EV17 type HFMD than among the children with CoxA6 type and Cox A10 type HFMD, however, the proportions of the children who had oral and perioral rashes, rashes on calf and forearm, rashes on neck and trunk, herpes and bullous eruption were significantly lower among the children with EV17 type HFMD than among the children with CoxA6 type and Cox A10 type HFMD(P<0.05).The levels of SAA, PCT and CRP of the children with EV71 type HFMD were significantly higher than those of the children with CoxA6 type and Cox A10 type HFMD(P<0.05).ROC curve analysis showed that set 426.44 mg/L as the critical value, the sensitivity and specificity of the SAA were respectively 88.89% and 93.55% in identification of EV71, and the area under curve(AUC) of the SAA was significantly higher than that of the PCT and CRP(P<0.05). CONCLUSION The

关 键 词：柯萨奇病毒A组6型 柯萨奇病毒A组10型 肠道病毒A71型 手足口病 血清淀粉样蛋白A 降钙素原 C-反应蛋白 

分 类 号：R512.5[医药卫生—内科学]