重症手足口病的早期识别

手足口病（HFMD）是由肠道病毒引起的呈全球性分布的感染性疾病，肠道病毒71型（EV71）及柯萨奇 A 组16型（CVA16）肠道病毒是导致此疾病的主要病毒。该病具有发病率高、病程进展迅速、死亡率高等特点。因 EV71病毒感染所具有的嗜神经性，重症患儿一般易出现神经系统损害，严重者会出现脑干脑炎、心肺功能衰竭而导致死亡。目前临床上，对于如何早期识别手足口病患儿的重症倾向、提前采取干预措施、改善预后、降低死亡率还是一个比较棘手和具有挑战的课题。通过文献复习对具有早期识别意义的且与病程进展密切相关的临床和实验室指标进行探讨，为临床及早识别预后差的手足口病患儿，进一步早期对重症手足口病采取针对性治疗干预措施、改善患儿预后，临床分级分层治疗提供依据和参考。

Early identification of severe hand,foot and mouth disease

Hand-foot-mouth disease （HFMD） is an infectious disease that caused by enterovirus which spreads in global distribution. Enterovirus 71 （EV71） type and coxsackievirus A 16 type （CVA16） are two major aetiological agents. It has the characteristic of high incidence rate, rapid progression and high mortality rate. Because EV71 is more likely to infect the nerve, the nervous system damage is more easily involved in severe HFMD children, and will evolve to brainstem encephalitis, cardiopulmonary failure and cause death in the process. It is a difficult and challenging task that how to recognise the severe HFMD tendency earlier, and timely interfere in the progression, improve prognosis, reduce mortality in the current clinical. In this review we discuss about the symptoms and laboratory index which maybe valuable for early identification, and if possible, find a statistically significant specific relationship between course of disease and indicators, in order to identify potential deterioration of children with HFMD, to provide a basis for hierarchical classification treatment, to achieve the goal of preventing condition worsening, and improving the prognosis in severe HFMD.