308例发热新生儿肠道病毒感染的临床特征分析  

Clinical characteristics of 308 febrile neonates with enterovirus infection

作　　者：赵玫[1] 高瑾[1] 施明[2] 李佳欣 杜琨[1] Zhao Mei;Gao Jin;Shi Ming;Li Jiaxin;Du Kun(Department of Neonatology,Kunming Children′s Hospital,Kunming 650034,China;Yunnan Second People′s Hospital,Kunming 650021,China)

机构地区：[1]昆明市儿童医院新生儿科,650034 [2]云南省第二人民医院,昆明650021

出　　处：《国际儿科学杂志》2023年第4期277-281,共5页International Journal of Pediatrics

基　　金：云南省卫生科技计划项目(2018NS0176)。

摘　　要：目的探讨在新生儿发热病例中,肠道病毒的感染率及其临床特征。方法选取2018年3月至2019年2月因发热症状收住于昆明市儿童医院新生儿病房的308例新生儿为研究对象,采集所有患儿的粪便标本及部分(271份)脑脊液标本,采用逆转录-聚合酶链反应(RT-PCR)法,分别检测粪便、脑脊液中的肠道病毒。明确发热新生儿肠道病毒感染率。将其分为肠道病毒感染组(n=91)、无肠道病毒感染组(n=217),分析两组患儿的临床资料,对两组新生儿临床表现及其实验室检查结果进行统计学比较。结果308例患儿中,91例检测到肠道病毒(肠道病毒通用型90例,柯萨奇病毒A16型1例),占所有患儿的29.55%。所有受检脑脊液标本中仅1例检出病毒RNA,占0.37%(1/271),明显低于粪便标本检出率29.55%(91/308)。肠道病毒感染者中,无死亡病例,有1例重症病例,除该重症病例自动出院外,其余均好转或治愈出院。肠道病毒感染组与非肠道病毒感染组临床表现比较,呼吸道症状及皮疹差异有统计学意义(均P<0.05),其他差异无统计学意义(均P>0.05)。肠道病毒感染的发病呈明显季节性[夏秋季占83.5%(76/91)]。结论在肠道病毒流行季节,对于发热新生儿,应将粪便肠道病毒列为常规检测项目,以提高诊断、治疗的准确性和及时性,避免不必要抗生素的应用及肠道病毒在新生儿病房暴发流行。Objective To investigate the prevalence of enterovirus infection and its clinical characteristics in neonatal febrile cases.Methods A total of 308 neonates in the neonatal ward of Kunming Children′s Hospital with febrile symptoms from March 2018 to February 2019 were selected for the study.Fecal specimens and some(271)cerebrospinal fluid specimens were collected from all neonates.Enterovirus was respectively detected in feces and cerebrospinal fluid by using reverse transcription-polymerase chain reaction(RT-PCR)method.The rate of enterovirus infection in febrile neonates was clarified.They were divided into enterovirus infection group(n=91)and no enterovirus infection group(n=217).The clinical data of the subjected neonates in the two groups were analyzed and the clinical manifestations of the neonates and their laboratory findings were compared statistically.Results Ninety-one enteroviruses(90 enterovirus were general type,and 1 was coxsackievirus A16 type)were detected in 308 children,accounting for 29.55%of all neonates.Viral RNA was detected in only 1 case[0.37%(1/271)]of all examined cerebrospinal fluid specimens,which was significantly lower than the detection rate of 29.55%(91/308)in fecal specimens.There were no fatal cases,but there was one severe case in enterovirus infection group.Except for the severe case which was discharged automatically,all of them improved or healed and discharged from hospital.The clinical manifestations of the enterovirus infection group were non-specific statistically compared with the non-enterovirus infection group(all P>0.05),except for respiratory symptoms and skin rash(all P<0.05).The incidence of enterovirus infection was significantly seasonal[83.52%(76/91)in summer and autumn].Conclusion In the epidemic season of enterovirus,it is recommended to list fecal enterovirus as a routine test item to improve the accuracy and timeliness of diagnosis and treatment,and avoid the application of unnecessary antibiotics and the outbreak of enterovirus in the neonatal ward.

关 键 词：肠道病毒 新生儿 发热 

分 类 号：R722.1[医药卫生—儿科]