长春市小儿手足口病临床特点及病原学分析

目的 了解长春市儿童医院2009至2010年住院的手足口病(hand foot and mouth disease,HFMD)患儿的临床表现及病原情况.方法 采集2009年5月至2010年11月在长春市儿童医院就诊的HFMD患儿1 862例的临床资料及患儿粪便和咽拭子标本,用RT-PCR方法对1 514份粪便标本进行肠道病毒71犁(enterovirus 71,EV71)和柯萨奇病毒A16型(Coxsackie virus A16,CoxA16)扩增,用人横纹肌肉瘤细胞对530份咽拭子标本进行病毒分离.结果 HFMD住院数2009年687人次,2010年1 175人次；其中重患率2009年6.26％( 43/687),2010年为16.51％( 194/1 175).季节分布:2009年6月及2010年6、7、8月为发病高峰月份.性别分布男1 241例,女621例.发病平均年龄(28.32±15.22)个月.城乡分布为1∶1.05.临床表现:100％出现皮疹；就诊时首发症状发热55.69％(1 037/1 862)、神经系统症状6.07％ (113/1 862)、呕吐1.41％ (26/1 862).病程中出现心肌损伤547例(29.41％),神经系统并发症548例(29.43％),呼吸系统并发症82例(4.39％).病毒分离阳性166例,阳性率31.32％.2009年EV71检出率9.62％,CoxA16检出率10.57％:2010年EV71检出率32.52％,CoxA 16检出率39.53％.结论 小儿HFMD发病数2010年较2009年增多,重患率亦增高；在夏秋季对发热患儿应注意HFMD;HFMD可引起消化系统、呼吸系统、循环系统、神经系统等多器官损害,重症患儿以神经系统损害为主；HFMD病原呈现多样性,以EV71和CoxA16为主,重患多数为EV71感染.

Clinical characteristics and pathogenic etiology of children with hand foot and mouth disease in Changchun city

Objective To learn the clinical manifestations and pathogenic situation of hand foot and mouth disease (HFMD) in Changchun children's hospital from 2009 to 2010.Methods We collected the faeces specimen and oropharyngeal swabs of 1 862 children patients who consulted in Changchun children's hospital from May 2009 to Nov 2010.The enterovirus 71 ( EV71 ) and Coxsackie virus A16 (CoxA16) of 1 514 faeces specimens were amplified with RT-PCR,and 530 oropharyngeal swabs' virus were isolated with rhabdomyosarcoma cell.Results The total HFMD patients were 1 175 in 2010,687 in 2009.The rate of serious patients was 6.26％ (43/687) in 2009,and 16.51％ ( 194/1 175 ) in 2010.The season of peak incidence in 2009 was June,and in 2010 were June,July and August.The gender distribution was 1 241 males and 621females.The average age of HFMD patients was ( 28.32 ± 15.22 ) months.And the distribution in city and countryside was 1:1.05.Total of 1 862 cases ( 100％ ) had rash,55.69％ ( 1 037/1 862) had fever,6.07％(113/1 862) had neurologic symptom and 1.41％ (26/1 862) had vomiting when the patients admitted in our hospital.And there were 547 cases ( 29.41％ ) emerging myocardium injury,548 cases (29.43％ ) emerging neurologic complications and 82 cases (4.39％ ) emerging respiratory complications during treatment.There were 166 positive with positive rate 31.32％ in virus isolation.The positive rate of EV71 and CoxA16 were 9.62％ and 10.57 in 2009,and 32.52％ and 39.53％ in 2010.Conclusion There were more HFMD patients in 2010 than 2009,and the proportion of serious patients was increased too.In summer and autumn,we should pay more attention to HFMD for fever children.HFMD could damage digestive system,respiratory system,circulatory system and nervous system.The nervous system of serious patients is more likely to be damaged.The pathogens of HFMD are diversity,but mainly are EV71 and CoxA16,and the pathogen of serious patients is mostly EV71.