CAJ | 학술논문

目的探讨不同肠道病毒所致手足口病的临床特征及发生中枢神经系统并发症(CNSC)的高危因素.方法分析272例手足口病患儿,其中肠道病毒71型(EV71)感染92例、柯萨奇病毒组16型(CA16)感染31例、非EV71非CA16感染149例.有CNSC 42例,无CNSC 230例.比较分析不同肠道病毒感染患儿的临床特征,同时对伴有CNSC者进行多因素Logistic分析.结果 3组不同肠道病毒感染患儿的年龄、外周血自细胞计数(WBCC)、C-反应蛋白(CRP)、血糖(BG)水平差异无显著性(P＞0.05);而体温、热程、中性粒细胞百分比(NP)、肢体抖动(MJOL)及CNSC发生率3组间差异有显著性(P＜0.05).多因素Logistic分析发现,MJOL、WBCC＞1.2×109/L、EV71感染是CNSC的高危因素,而且MJOL具有最大相对危险度(OR=242.848,P=0.000).Logistic线性预测因子Z=-12.825+5.492(MJOL)+2.624(WBCC＞1.2×109/L)+1.900(FV71感染).结论 (1)EV71感染者比其他肠道病毒感染者有更高体温、NP、CNSC及MJOL发生率,热程比CA16感染者更长.(2)FV71感染、MJOL、WBCC＞1.2 x109/L是手足口病发生CNSC的高危因素,尤其MJOL对预测CNSC有重要意义.
목적 탐토불동장도병독소치수족구병적림상특정급발생중추신경계통병발증(CNSC)적고위인소.방법 분석272례수족구병환인,기중장도병독71형(EV71)감염92례、가살기병독조16형(CA16)감염31례、비EV71비CA16감염149례.유CNSC 42례,무CNSC 230례.비교분석불동장도병독감염환인적림상특정,동시대반유CNSC자진행다인소Logistic분석.결과 3조불동장도병독감염환인적년령、외주혈자세포계수(WBCC)、C-반응단백(CRP)、혈당(BG)수평차이무현저성(P＞0.05);이체온、열정、중성립세포백분비(NP)、지체두동(MJOL)급CNSC발생솔3조간차이유현저성(P＜0.05).다인소Logistic분석발현,MJOL、WBCC＞1.2×109/L、EV71감염시CNSC적고위인소,이차MJOL구유최대상대위험도(OR=242.848,P=0.000).Logistic선성예측인자Z=-12.825+5.492(MJOL)+2.624(WBCC＞1.2×109/L)+1.900(FV71감염).결론 (1)EV71감염자비기타장도병독감염자유경고체온、NP、CNSC급MJOL발생솔,열정비CA16감염자경장.(2)FV71감염、MJOL、WBCC＞1.2 x109/L시수족구병발생CNSC적고위인소,우기MJOL대예측CNSC유중요의의.
Objective To investigate clinical features of hand foot and mouth disease (HFMD)caused by different enterovirus types and high-risk factors for central nervous system complications (CNSC).Methods We studied 272 children with HFMD. There were 92 patients with enterovirus71 ( EV71) infection,31 patients with coxsackievirus A16 (CA16) infection, 149 patients with non-EV71 and non- CA16 types infection. There were 42 patients with CNSC, 230 children without CNSC. We compared the clinical features of three groups with different enterovirus types infection,and analyzed high-risk factors of CNSC by the multiple logistic regression analysis. Results There were no significant differences of age,white-blood cell count(WBCC) ,C-reactive protein(CRP) ,blood glucose(BG) among three groups. However,there were significant differences of peak body temperature, fever time, neutrophils percentage(NP), incidences of CNSC and myoclonic jerk of limb(MJOL) among three groups. We found that MJOL、 WBCC over 1.2×109/L、EV71 infection were significant high-risk factors for CNSC by multiple logistic regression analysis. And MJOL was the most significant prognostic factor (odds ratio 242. 848, P = 0. 000),followed by WBCC over 1.2×109/L, EV71 infection. The linear predictor in the model was as follows: Z = -12. 825+5. 492 (MJOL) + 2. 624 ( WBCC over 1.2×109/L) + 1. 900 ( EV71 infection). Conclusion The patient of EV71 infection has higher peak body temperature,higher NP、higher incidence of CNSC and MJOL compared with patients of other enterovirus types infection. MJOL、WBCC over 1.2×109/L、EV71 infection are high-risk factors for CNSC in patients with HFMD. It is especially important for MJOL to predict CNSC.