手足口病流行期间主要病原体所致疱疹性咽峡炎的临床分析

目的 对手足口病流行期间主要病原体所致疱疹性咽峡炎进行临床分析.方法 收集94例手足口病流行期间住院的疱疹性咽峡炎患儿的临床资料,采用实时-聚合酶链反应技术检测肠道病毒71型（EV71）、A组柯萨奇病毒16型（CoxA 16）感染情况,并进行相关指标比较.结果 94例疱疹性咽峡炎患儿中,EV71阳性34例（36.17％,34/94）（EV71阳性组）,CoxA 16阳性31例（32.98％,31/94）（CoxA 16阳性组）.EV71阳性组和CoxA 16阳性组白细胞计数、空腹血糖、红细胞沉降率、超敏C反应蛋白均较正常明显升高,但两组间比较差异无统计学意义（P＞0.05）;而心肌酶谱、肌酐、尿素氮在正常范围内,两组间比较差异无统计学意义（P＞0.05）.EV71阳性组和CoxA 16阳性组年龄＜3岁比例、持续高热（腋温＞ 39℃）的发生率比较差异无统计学意义（P＞0.05）,而EV71阳性组神经、呼吸、循环系统异常的发生率明显高于CoxA 16阳性组26.47％ （9/34）比6.45％（2/31）、23.53％（8/34）比3.23％（1/31）、20.59％（7/34）比3.23％（1/31）],差异有统计学意义（P＜0.05）.94例疱疹性咽峡炎患儿中,11例为重症（11.70％,11/94）,EV71阳性组9例,CoxA16阳性组2例.2例因肺出血死亡,出现瘫痪1例,均为EV71阳性组.结论 同一时期疱疹性咽峡炎与手足口病的主要病原体可能具有平行性,手足口病流行期间的疱疹性咽峡炎患儿应纳入到手足口病来进行统一管理;而且EV71阳性患儿病情较CoxA 16阳性患儿重,检测病原体有助于判断预后.

Clinical analysis of herpangina caused by major pathogens during outbreak of hand-foot-mouth disease

Objective To analyze the clinical characteristics of herpangina caused by major pathogens during outbreak of hand-foot-mouth disease （HFMD）.Methods The clinical data of 94 patients with herpangina during outbreak of HFMD were collected.Enteroviruses 71 （EV71） and Coxsackie virus A16 （CA16） were detected by real-time polymerase chain reaction.And relevant indicators of two groups were compared.Results There were 34 cases EV71 positive （36.17%,34/94,EV71 positive group） and 31 cases CoxA 16 positive （32.98%,31/94,CoxA 16 positive group） from the results of pathogen detection.The level of white blood cell count,glucose,erythrocyte sedimentation rate,hypersensitive C-reactive protein were increased obviously than normal,while no significant difference was found between two groups （P 〉 0.05）.The level of myocardial enzymes,creatinine,blood urea nitrogen were in the normal range and no significant difference was found between two groups （P 〉 0.05）.There was no significant difference between two groups in the incidence of age 〈 3 years old,persistent high fever （P 〉 0.05）.The abnormalities performance in the nervous,respiratory,circulatory system of the EV71 positive group were significantly higher than those in CoxA 16 positive group 26.47% （9/34） vs.6.45% （2/31）,23.53% （8/34） vs.3.23%（1/31）,20.59% （7/34） vs.3.23% （1/31） separately],and there were significant differences between two groups（P 〈 0.05）.There were 11 severe cases （11.70%,11/94） in the 94 cases of children with herpangina,and 9 cases belonged to the EV71 positive group,2 cases belonged to the CoxA16 positive group.Two cases died of lung hemorrhage,1 case occurred of paralysis,all of them were detected EV71 positive.Conclusions The pathogen of herpangina might be same as the pathogen during the outbreak of HFMD.Children with herpangina during outbreak of HFMD should be incorporated into the management of HFMD.EV71 positive children are serious than CoxA16 positive cases,and detecting