轻型和重型手足口病临床和实验室特征分析

目的 研究2008年深圳市轻型和重型手足口病临床特点和实验室特征.方法 将深圳市东湖医院和儿童医院共145例手足口病住院患者作为研究对象,其中轻型124例,重型21例.收集患者临床和一般实验室资料,急性期与恢复期连续粪便和血标本,通过RT-PER检测EV71病毒核酸,分离和培养EV71肠道病毒,其中2例死亡患者行病理组织学检测.结果 与轻型患者比较,重型患者白细胞计数、血糖显著升高,但年龄显著降低,粪便中轻型和重型患者EV71基因检出率分别为35%与67%,重型患者EV71检出率显著高于轻型患者,从9例患者粪便中分离培养出肠道病毒,其中1例为死亡患者粪便标本.2例患者死于神经源性肺水肿和脑干脑炎.结论 EV71是重型患者和死亡患者的最主要病原体,神经源性肺水肿和脑干脑炎是EV71型手足口病的最主要死亡原因,对年龄小于4岁,高热、皮疹稀疏和高血糖的EV71型手足口病患者应警惕向重型发展.

Study of the clinical and laboratory features of hand-foot-mouth disease

Objective To study the clinical and laboratory features of the mild and severe hand-foot-mouth diseases (HFMD) in Shenzhen in 2008.Methods 145 cases were observed in East-Lake Hospital and Shenzhen Children's Hospital. Of the 145 cases,124 mild eases and 21 severe cases were involved. All the clinical data and Laboratory findings were collected and summarized. After collection of the acute and convalescent consecutive stools and peripheral bloods from the patients with HFMD,EV71 genes were amplified from these samples by RT-PCR. Enterovirus 71 were cultured and isolated using Veto cell line and R&D cell line. Results The WBC counts and blood glucose levels of the severe cases were significantly elevated,but the ages of the severe ones significantly decreased compared with those of the mild cases( P < 0.05). EV71 genes could be detected by RT-PCR with 35% positive rate in mild cases and 67% in severe eases.The EV71 gene detection rate of the severe cases was significantly increased in contrast to that of the mild ones. The EV71 were isolated and cultured from the stools of 9 patients,one specimens from the dead's stool. Two severe cases died of neurngenic pulmonary edema and brain-stem encephalitis. Conclusions EV71 mainly contributes to HFMD and is responsible for death of some severe cases. High fever,less rash,elevated white blood cell counts and blood glucose concentrations as well as age less than 4 years old should be used for prediction of severe cases.