儿童重症手足口病的临床特征和预后以及预警指标分析  

Analysis of the clinical features,prognosis and early warning indicators of severe hand,foot and mouth disease

作　　者：嵇红 陈庆会[3] 张雪峰[2] 施超[4] 毕俊[5] 艾静[2] 樊欢[2] 田健美[3] 鲍倡俊[2] 金玉[1,6] Ji Hong;Chen Qinghui;Zhang Xuefeng;Shi Chao;Bi Jun;Ai Jing;Fan Huan;Tian Jianmei;Bao Changjun;Jin Yu(Medical School of Nanjing University,Nanjing 210093,China;Jiangsu Province Center for Disease Control and Prevention,Nanjing 210009,China;The Affiliated Children's Hospital of Suzhou University,Suzhou 211166,China;Wuxi Municipal Center for Disease Control and Prevention,Wuxi 214023,China;Xuzhou Municipal Center for Disease Control and Prevention,Xuzhou 221006,China;The Affiliated Children's Hospital of Nanjing Medical University y Nanjing 210008,China)

机构地区：[1]南京大学医学院,210093 [2]江苏省疾病预防控制中心,210009 [3]苏州大学附属儿童医院,211166 [4]无锡市疾病预防控制中心,214023 [5]徐州市疾病预防控制中心,221006 [6]南京医科大学附属儿童医院,210008

出　　处：《中华实验和临床病毒学杂志》2021年第1期89-95,共7页Chinese Journal of Experimental and Clinical Virology

基　　金：国家自然科学基金(81672020,81402732);江苏省卫生计生委青年人才项目(QNRC2016552)。

摘　　要：目的探讨肠道病毒71型(enterovirus A group 71 type,EV-A71)疫苗上市前重症手足口病(hand,foot and mouth disease,HFMD)中枢神经系统(central nervous system,CNS)并发症的类型、严重程度,为重症HFMD临床演变提供基础数据。方法采用描述性分析对2010-2016年南京市儿童医院、苏州大学附属儿童医院、无锡市人民医院、徐州市儿童医院报告的3583例实验室确诊的重症HFMD的一般情况、临床表现、实验室指标进行统计,应用Logistic回归筛选增加HFMD严重程度的预警指标。结果重症HFMD病死率为8.09‰(29/3583),入住儿科重症监护室(pediatric intensive care unit,PICU)率为11.75%(421/3583),出院未愈的发生率为5.30‰(19/3583),其中CNS并发症轻微组占39.02%(1398/3583),严重组占59.22%(2122/3583),危重组占1.76%(63/3583)。危重组发病年龄在6~11月龄、不典型疹、呼吸系统症状/体征(气急、呼吸减慢、呼吸困难等)、神经系统症状/体征(手足抖动、抽搐、嗜睡、昏睡等)、循环系统症状/体征(心率加快、皮肤颜色异常、心律失常、四肢发凉等)、实验室检查(白细胞计数升高、淋巴细胞计数升高、血小板计数升高、C反应蛋白升高等)、临床辅助检查(脑电图、脑CT、胸片X线)等指标发生率在危重组高于其他2组,且有统计学差异(P<0.05)。Logistic回归模型显示:呼吸减慢、呕吐、脑膜刺激征等11个变量随着异常比例增大,CNS并发症严重程度升高(P<0.05)。结论易惊、呼吸减慢、呕吐、淋巴细胞升高、脑电图异常等指标对于重症HFMD患儿进展为不同严重程度的CNS并发症具有重要的临床意义。Objective To explore the type distribution and severity of central nervous system(CNS)complications in severe hand,foot and mouth disease(HFMD)cases prior to the introduction of human enterovirus A group 71 type(EV-A71)vaccine,and provide scientific data for early clinical intervention.Methods A total of 3583 laboratory-confirmed severe HFMD cases in Jiangsu province during 2010-2016 were collected and analyzed retrospectively.Related early warning signs of increased HFMD severity were estimated with logistic regression analyses.Results The severity-fatality rate,severity-pediatric intensive care unit(PICU)admission rate,and sequelae rate were 8.09‰(29/3583),11.75%(421/3583)and 5.30‰(19/3583).Of them,39.02%(1398/3583)patients suffered from mild CNS involvement,59.22%(2122/3583)patients suffered from severe CNS involvement,1.76%(63/3583)suffered from critical CNS involvement.The rates of the cases whose age of onset was 6-11 months,the rates of cases with atypical rash,respiratory-related signs and symptoms(shortness of breath,slowed breathing,dyspnea,etc),neurological-related signs and symptoms[hand and foot shaking,convulsions,lethargy(sleepiness),etc],circulatory-related system signs and symptoms(faster heart rate,abnormal skin color,arrhythmia,cold limbs),laboratory-related indicators(increased white blood cell count,increased lymphocyte count,increased platelet count,increased C-reactive protein,etc),clinical auxiliary examination[electroencephalogram(EEG),brain CT,chest X-ray]were highest in the critical CNS involvement group,and the differences were significant(P<0.05).Multivariate logistic regression analysis showed that with the increase of proportion of convulsions,slowed breathing,vomiting,meningeal irritation and other 7 variables,the severity of CNS complications increased(P<0.05).Conclusions The indicators such as easily startled,slow breathing,vomiting,elevated lymphocytes,abnormal EEG and other indicators have important clinical significance for children with severe HFMD to progress to CNS comp

关 键 词：手足口病 重症病例 中枢神经系统 并发症 肠道病毒71型 

分 类 号：R725.1[医药卫生—儿科]