疱疹性咽峡炎与手足口病的相关性研究进展

疱疹性咽峡炎(herpangina,HA)与手足口病(hand-foot-mouth disease,HFMD)均是由肠道病毒感染引起的急性传染性疾病,在许多方面都有相似之处。首先,二者感染源高度重合,且不同地区流行株之间VP1区域序列无明显差异,同源性较高。其次,二者流行特征有许多相似之处:均以夏季多发、易感人群均为低年龄段婴幼儿。同时在临床表现与预后方面,两者也有一定的相关性:HA临床表现为咽峡与软腭处的疱疹及溃疡,伴有发热、喉痛与食欲减退,预后较好;HFMD临床表现为口腔颊、舌黏膜处溃疡,与手部、足部、膝部与臀部的特征性水疱,可出现重症型。一方面,虽然多数HA具有自限性且预后良好,但有文献表明具有特定临床表现如腹泻、呕吐、肢体抖动、嗜睡的HA有可能进展为HFMD,另一方面,早期出现的HA是重症HFMD的危险因素,重症HFMD甚至仅表现为口腔咽峡部疱疹。医护人员应重视对HA临床表现的观察,尽早识别潜在的HFMD患儿,防止其进一步发展或转化。

Research progress on the correlation between herpangina and hand-foot-mouth disease

As acute enterovirus-induced infections,herpangina(HA) and hand-foot-mouth disease(HFMD) are similar in many aspects.Although these diseases vary with time and region,many studies have shown that the viruses causing HA and HFMD are consistent,and there is no notable difference in partial VP1 gene sequences between different viruses.HA and HFMD also resemble each other in epidemiological features.Both infections show significant summertime seasonality,have a strong connection with certain environmental conditions and are most prevalent in young children and infants.Herpangina is thought to be a mild disease,defined as vesicular enanthem and then ulcers of the fauces and soft palate with presentation of fever,sore throat,and decreased appetite.HFMD,which could lead to severe symptoms,is also characterized by oral ulcers,although they are chiefly on the buccal mucosa and tongue,and typical vesicular rashes,which are most commonly found on the hands,feet,knees and buttocks.While HA is generally believed to be self-limited and has a favorable prognosis,HA with certain clinical characteristics,such as diarrhea,vomiting,limb jitter and sleepiness,can evolve into HFMD,according to some literature in recent years.However,HA is an independent risk factor for HFMD,and severe cases only present with herpes appearing at the isthmus of the fauces at an early stage,which indicates a strong correlation between them.Clinical manifestations of HA should be considered by medical staff to identify potential children with HFMD as early as possible to prevent its further development or transformation.