CAJ | 학술논문

目的分析2009至2010年我院传染科收治住院的重症手足口病患儿的临床及流行病学特点,寻找重症相关危险因素.方法收集2009年及2010年因手足口病住院,且临床分期2期及2期以上患儿的临床资料及相关实验室检查,共748例,进行回顾性分析.结果 748例重症手足口病住院患儿中,2009年271例,危重症3期17例(6.3％).2010年477例,3期7例(1.5％),3期危重病例比重较2009年降低(x2=12.836,P＜0.01).临床表现2期患儿724例,3期危重症24例,其中7例死亡,3期患儿病死率与2期比较,差异有统计学意义(P＜0.01).男470例(62.8％),女278例(37.2％),男女比为1.7∶1.年龄3个月10 d ～12岁9个月,中位年龄25个月,以1～4岁为主,达577例(77.1％).本组均有不同程度的发热,2期患儿热程(4.10±1.40)d,3期为(5.05±1.05)d,3期热程较2期长(t=3.173,P＜0.01).四肢抖动(57.0％)及呕吐(62.3％)是重症患儿病程中最常见的伴随症状,肺水肿、肺出血是最严重的并发症.3期患儿血白细胞计数( 14.8±6.25)× 109/L,血糖(8.63 ±3.51) mmo]/L,与2期患儿血白细胞计数(11.8±4.23)×109/L,血糖(5.51±2.14) mmol/L比较,差异有统计学意义(P＜0.01),而C反应蛋白及脑脊液白细胞计数2期和3期患儿差异无统计学意义.182例患儿行头颅MRI检查,表现异常者37例(20.3％),主要表现为脑干(11例)等部位的高信号,有1例3期重症死亡患儿表现为脑水肿.结论手足口病的流行有一定的区域性及季节性,与家庭经济、卫生条件和性别都有一定的关系.1～4岁儿童为手足口病高发年龄.高热持续不退,是重症危险因素.而外周血白细胞、血糖水平的升高,磁共振等影像学检查可作为实验室预警指标.
목적 분석2009지2010년아원전염과수치주원적중증수족구병환인적림상급류행병학특점,심조중증상관위험인소.방법 수집2009년급2010년인수족구병주원,차림상분기2기급2기이상환인적림상자료급상관실험실검사,공748례,진행회고성분석.결과 748례중증수족구병주원환인중,2009년271례,위중증3기17례(6.3％).2010년477례,3기7례(1.5％),3기위중병례비중교2009년강저(x2=12.836,P＜0.01).림상표현2기환인724례,3기위중증24례,기중7례사망,3기환인병사솔여2기비교,차이유통계학의의(P＜0.01).남470례(62.8％),녀278례(37.2％),남녀비위1.7∶1.년령3개월10 d ～12세9개월,중위년령25개월,이1～4세위주,체577례(77.1％).본조균유불동정도적발열,2기환인열정(4.10±1.40)d,3기위(5.05±1.05)d,3기열정교2기장(t=3.173,P＜0.01).사지두동(57.0％)급구토(62.3％)시중증환인병정중최상견적반수증상,폐수종、폐출혈시최엄중적병발증.3기환인혈백세포계수( 14.8±6.25)× 109/L,혈당(8.63 ±3.51) mmo]/L,여2기환인혈백세포계수(11.8±4.23)×109/L,혈당(5.51±2.14) mmol/L비교,차이유통계학의의(P＜0.01),이C반응단백급뇌척액백세포계수2기화3기환인차이무통계학의의.182례환인행두로MRI검사,표현이상자37례(20.3％),주요표현위뇌간(11례)등부위적고신호,유1례3기중증사망환인표현위뇌수종.결론 수족구병적류행유일정적구역성급계절성,여가정경제、위생조건화성별도유일정적관계.1～4세인동위수족구병고발년령.고열지속불퇴,시중증위험인소.이외주혈백세포、혈당수평적승고,자공진등영상학검사가작위실험실예경지표.
Objective To retrospectively analyzed the clinical features and epidemiology of children with severe hand-foot-and-mouth disease during 2009 and 2010 in Shanghai to investigate some risk factors with fatal cases.Method All the clinical records and laboratory results of serious patients were collected.A retrospective study was performed.Result A total of 748 serious patients were enrolled into this study,and the ratio of male to female was about 1.7∶1 ; 724 patients were categorized into stage 2 with 254 patients in 2009 and 470 in 2010; 24 patients were categorized into stage 3 with 17 in 2009 and 7 in 2010.The rate of severity in 2010( 1.5％ ) was lower than in 2009(6.3％ ) (x2 =12.836,P ＜0.01 ).Seven patients of stage 3 died,with the fatality 29.2％,which was higher than in stage 2 ( P ＜ 0.01 ).The children aged between 3 months 10 days to 12 years 9 months with onset median age of 25 months.Among them,77.1％ patients aged between 1 and 4 years which also accounted for 79.2％ of the fatal cases(19/24).But there was no significant difference between the age and the severity( x2 =0.804,P ＞ 0.05 ).Fever( 100％ ),vomiting(57.0％ ) and myoclonus jerk(62.3％ ) were the most frequent symptoms occurred in those serious cases.The average period of fever in children of stage 2 and 3 was (4.10 ± 1.40)d and (5.05 ± 1.05)d,respectively,which indicated significant difference between the two groups ( t =3.173,P ＜ 0.05 ). The average values of white-blood-cell counts and blood glucose in fatal patients were ( 14.8 ± 6.25 ) × 109/L and (8.63 ±3.51 ) mmol/L.They were higher when compared to those in stage 2 with the white-blood-cell counts of ( 11.8 ±4.23) × 109/L and blood glucose of (5.51 ±2.14) mmol/L(P ＜0.05).But there was no significant difference in C-reactive protein or cerebrospinal fluid white-blood-cell counts; A total of 182 patients were enrolled for MRI study during the acute stage with 37 (37/182,20.3％ ) presented abnormal findings.Among them,most frequent findings were hyperintense lesions seen in brain stem ( 11 eases).A stage 3 case who died presented brain edema on MRI examination.Conclusion The epidemic of HFMD has some correlation with the area,season,health condition of the family and gender of the children.Children under 4 years of age especially those who lived in rural areas were susceptible to the HFMD. Frequent vomiting or myoclonus jerk may indicate the central nervous system involvement. But persistent high fever may indicate tendency to deteriorate.Some laboratory examinations can help find the fatal cases at an early time.