CV⁃A6血清型手足口病重症病例临床风险分析  

Clinical risk of severe cases of HFMD with CV⁃A6 serotype

作　　者：杨雅倩 郑志刚 潘沛江 陈华凤[4] 彭远军 卢振伟 廖艳研 王海龙 周丽娟 梁浩 陈敏玫[4] 叶力 YANG Yaqian;ZHENG Zhigang;PAN Peijiang;CHEN Huafeng;PENG Yuanjun;LU Zhenwei;LIAO Yanyan;WANG Hailong;ZHOU Lijuan;LIANG Hao;CHEN Minmei;YE Li(School of Public Health,Guangxi Medical University&Guangxi Key Laboratory of AIDS Prevention and Research,Nanning,Guangxi 530021,China;Department of Epidemiology,School of Public Health and Management,Guangxi University of Traditional Chinese Medicine,Nanning,Guangxi 530200,China;Life Sciences Institute,Guangxi Medical University&China(Guangxi)-ASEAN Joint Laboratory of Emerging Infectious Diseases,Nanning,Guangxi 530021,China;Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention,Nanning,Guangxi 530028,China)

机构地区：[1]广西医科大学公共卫生学院&广西艾滋病防治研究重点实验室,广西南宁530021 [2]广西中医药大学公共卫生与管理学院流行病学教研室,广西南宁530200 [3]广西医科大学生命科学研究院&中国(广西)-东盟新发传染病联合实验室,广西南宁530021 [4]广西壮族自治区疾病预防控制中心,广西南宁530028

出　　处：《热带医学杂志》2024年第9期1224-1229,I0003,共7页Journal of Tropical Medicine

基　　金：广西自然科学基金项目(2017GXNSFAA198369);广西科技计划项目(桂科AD23026283)。

摘　　要：目的对柯萨奇病毒A6型(CV⁃A6)感染者的临床特征和转重症风险进行分析,探究相关风险因素,为CV⁃A6感染导致的重症手足口病的防治提供科学依据。方法收集2017-2018年广西壮族自治区重症手足口病病例个案资料,采用描述性分析、方差分析、χ^(2)检验、限制性立方样条进行分析。结果纳入578例重症手足口病病例,以散居儿童为主(94.12%),血清型分型以CV⁃A6和肠道病毒A71型(EV⁃A71)为主,分别占比53.11%和33.74%,不同血清型重症手足口病在居住地址、学龄分组、照看者、发病至确诊重症时间方面差异均有统计学意义(χ^(2)/F=79.452、20.935、258.178、4.454,P均<0.05)。不同血清型患者手、足、口、臀部及四肢等部位出疹情况差异均有统计学意义(χ^(2)=12.287、17.625、15.777、46.690、10.754,P均<0.05);CV⁃A6主要表现为典型手足口病皮疹情况。不同血清型患者在精神差/嗜睡、头痛、谵妄、肌阵挛、惊厥、急性弛缓性麻痹等神经系统损伤方面差异均有统计学意义(χ^(2)=120.835、83.329、7.901、38.622、13.312、11.173,P均<0.05);与EV⁃A71比较,CV⁃A6出现严重神经系统损伤的比例更低,但具有更高的转重症风险。手足口病在随着发病至诊断重症时间间隔>2 d后,进入ICU的风险呈现上升趋势(P<0.05)。结论手足口病病原体类型正在不断变化,CV⁃A6逐渐成为手足口病的优势血清型,具有较高的转重症风险,须加强手足口病病原体的监测及检测工作。Objective To analyze the clinical characteristics and the risk of severe disease of patients with coxsackievirus A6(CV⁃A6)serotype infection,explore the relevant risk factors,and provide a scientific basis for the prevention and treatment of severe hand⁃foot⁃and⁃mouth disease(HFMD)infected by CV⁃A6.Method Data of severe HFMD in Guangxi Zhuang Autonomous Region from 2017 to 2018 were collected,and analyzed by descriptive analysis,variance analysis,χ^(2) test,and restricted cubic spline curve based on logistic regression.Results A total of 578 cases of severe HFMD were included,mainly scattered children(94.12%),and the serotypes were mainly CV⁃A6 and enterovirus A71(EV⁃A71),accounting for 53.11%and 33.74%,respectively.There were significant differences between different serotypes of severe HFMD in terms of residential address,school age subgroups,caregivers and time from onset to diagnosis of severe illness(χ^(2)/F=79.452,20.935,258.178,4.454;all P<0.05).There were significant differences in rash in hands,feet,mouth,buttocks and limbs among different serotypes(χ^(2)=12.287,17.625,15.777,46.690,10.754;all P<0.05);the main manifestation of CV⁃A6 was typical rash of HFMD.Patients with different serotypes infections were different in neurological impairments such as bad spirit/somnolence,headache,delirium,myoclonus,convulsion and acute flaccid paralysis(χ^(2)=120.835,83.329,7.901,38.622,13.312,11.173;all P<0.05),and CV⁃A6 had a lower proportion of severe neurological impairments compared with EV⁃A7 but had a higher risk of transfer to critical care.HFMD showed an increasing risk of ICU admission after an interval of>2 days from onset to diagnosis of severe illness(P<0.05).Conclusions The pathogen type of HFMD was constantly changing,and CV⁃A6 had gradually become the dominant serotype,with a higher risk of becoming severe.It was necessary to strengthen the monitoring and detecting of HFMD pathogens.

关 键 词：重症手足口病 CV⁃A6 转重症风险 

分 类 号：R512.5[医药卫生—内科学]