205例手足口病合并惊厥患儿的病原学及临床特征  

Etiology and clinical characteristics of 205 children with hand,foot and mouth disease complicated with convulsions

作　　者：张玉凤[1] 符佳[1] 王军[1] 徐鹏飞[1] 袁娟[1] 刘瑞清[1] 唐甜甜 邓慧玲[1,2] Zhang Yufeng;Fu Jia;Wang Jun;Xu Pengfei;Yuan Juan;Liu Ruiqing;Tang Tiantian;Deng Huiling(The 2nd Department of Infectious Diseases,Xi’an Children’s Hospital,Xi’an 710003,China;Pediatrics,Xi’an Central Hospital,Xi’an 710003,China)

机构地区：[1]西安市儿童医院感染二科,西安市710003 [2]西安市中心医院儿科,西安市710003

出　　处：《中华实验和临床感染病杂志（电子版）》2021年第1期53-59,共7页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：西安市科技计划项目[No.201805098YX6SF32(7)];陕西省科技统筹重点产业创新链工程计划资助项目(No.2016KTZDSF02-04)。

摘　　要：目的探讨手足口病(HFMD)合并惊厥患儿的病原学及临床特征。方法选择西安市儿童医院2019年1月至12月收治的手足口病合并惊厥的患儿为研究对象,收集患儿的年龄、性别、个人史、症状、体征与临床转归等临床资料,采集其肛拭子,应用逆转录聚合酶链式反应PCR(RTPCR)对患儿标本进行病毒检测。结果2019年本院共收治手足口病合并惊厥的患儿205例,其中重症病例34例,普通病例171例(包括热性惊厥单纯型134例、复杂型30例、癫痫7例)。肛拭子病原学核酸检测肠道病毒核酸阳性195例(95.1%),其中血清学分型CA6患儿124例(60.5%),EV71分型患儿7例(3.4%),CA16分型患儿7例(3.4%),CA10分型患儿5例(2.4%),其他肠道病毒感染患儿52例(25.4%)。34例重症患儿中,CA6感染23例(67.6%),EV71感染2例(5.9%,其中1例放弃治疗后死亡),CA10感染2例(5.9%),CA16感染1例(2.9%),其他肠道病毒感染4例(11.8%),肠道病毒阴性2例(5.9%)。CA6分型患儿皮疹形态以大疱样皮疹为主,恢复期可出现脱皮、脱甲,EV71病例皮疹表现为小、厚、硬、少;入组病例经镇静止惊及对症支持治疗后仅1例因放弃治疗后死亡,余患儿均临床治愈出院。结论2019年本院手足口病合并惊厥患儿病原以CA6为主,其所致手足口病皮疹以大疱表现为主,恢复期可出现脱皮、脱甲;死亡病例仍为EV71所致。Objective To investigate the etiology and clinical characteristics of hand,foot and mouth disease(HFMD)complicated with convulsion.Methods Children of HFMD complicated with convulsion admitted to Xi’an Children’s Hospital from January to December in 2019 were selected.Age,gender,personal history,symptoms,physical signs and clinical outcome of children were collected,respectively,while the anal swabs were collected,and virus samples were detected by reverse transcription-polymerase chain reaction(RTPCR).Results In 2019,children of HFMD complicated with convulsion were treated in Xi’an Children’s Hospital,including 34 severe cases and 171 mild cases.After etiological detection,195 cases(95.1%)were positive for enterovirus nucleic acid,among whom,124 cases(60.5%)were serotyped CA 6,7 cases(3.4%)were serotyped EV71,7 cases(3.4%)were serotyped CA16,5 cases(2.4%)were serotyped CA10 and 52 cases(25.4%)were with other enteroviruses.Among the 34 severe cases,23 cases(67.6%)were infected with CA6,2 cases with EV71(5.9%)infeciton(one case died after giving up treatment),one case(2.9%)with CA16 infection,other enterovirus infection were found in 4 cases(11.8%)and 2 cases(5.9%)with enterovirus negative.Among the cases with CA6 infection,bullous rash was the main form,desquamation and nail removal may occur in convalescent stage.Among the cases with EV71 infection,the rash was small,thick,hard and few.After stasis shock and symptomatic supportactive treatment,only one case died due to abandoning treatment,and the rest cases were clinically cured and discharged.Conclusions CA6 was the main pathogen of HFMD complicated with convulsion in our hospital in 2019.The skin rash of HFMD caused by CA6 was mainly bullae,desquamation and nail removal could occur in convalescent period.Dead cases were still caused by EV71 infection.

关 键 词：手足口病 惊厥 临床特点 病原学 柯萨奇病毒A6型 

分 类 号：R725.1[医药卫生—儿科] R720.597[医药卫生—临床医学]