CAJ | 학술논문

目的：研究2012至2013年四川地区手足口病合并神经系统损害的患者的流行病学、病原学及临床特征，为防治该病提供一定的依据。方法回顾性分析2012年1月至2013年12月住院治疗的手足口病合并神经系统损害的179例患儿的流行病学、病原学及临床特征。结果本组病病例年龄5个月～6岁，平均年龄（1.39±0.34）岁，以婴幼儿（＜3岁）最多见（132/179，73.74%），且男︰女（1.75︰1）；发病高峰在4～8月份（132/179，73.74%）；患儿多有手足口病患儿接触史（48/179，26.82%）、饭前少洗手或不洗手（56/179，31.28%）、经常咬手指或玩具（89/179，49.72%）等危险因素。早期临床表现为皮疹（100%）、发热（169/179，94.41%）及易惊（134/179，74.86%）、肢体抖动（53/179，29.61%）、嗜睡（46/179，25.70%）、呕吐（36/179，20.11%）、易激惹（27/179，15.08%）、抽搐（21/179，11.73%）以及饮水呛咳（6/179，3.35%）等神经系统受损表现。病原学以EV71为主（85/121，70.25%），可有白细胞增多（72/179，40.22%）、C-反应蛋白升高（59/179，32.96%）、心肌酶谱升高（16/179，8.94%）及血糖升高（10/179，5.59%）等。对152例患儿行腰椎穿刺术，脑脊液均为无色透明，部分患儿脑脊液压力升高（65/179，42.76%）、白细胞计数增高（57/179，31.84%）；可伴有不同程度的蛋白、葡萄糖和氯化物改变。经治疗后，治愈123例（123/179，68.72%），好转51例（51/179，28.49%），死亡5例（5/179，2.79%），均死于脑干脑炎。结论四川地区手足口病的疫情发生有明显的性别、年龄和季节等差异。不良的卫生习惯、早期非特异性的临床症状、生化学异常及脑脊液改变是手足口病合并神经系统受损的警示信号，应早期识别和治疗。
목적：연구2012지2013년사천지구수족구병합병신경계통손해적환자적류행병학、병원학급림상특정，위방치해병제공일정적의거。방법회고성분석2012년1월지2013년12월주원치료적수족구병합병신경계통손해적179례환인적류행병학、병원학급림상특정。결과본조병병례년령5개월～6세，평균년령（1.39±0.34）세，이영유인（＜3세）최다견（132/179，73.74%），차남︰녀（1.75︰1）；발병고봉재4～8월빈（132/179，73.74%）；환인다유수족구병환인접촉사（48/179，26.82%）、반전소세수혹불세수（56/179，31.28%）、경상교수지혹완구（89/179，49.72%）등위험인소。조기림상표현위피진（100%）、발열（169/179，94.41%）급역량（134/179，74.86%）、지체두동（53/179，29.61%）、기수（46/179，25.70%）、구토（36/179，20.11%）、역격야（27/179，15.08%）、추휵（21/179，11.73%）이급음수창해（6/179，3.35%）등신경계통수손표현。병원학이EV71위주（85/121，70.25%），가유백세포증다（72/179，40.22%）、C-반응단백승고（59/179，32.96%）、심기매보승고（16/179，8.94%）급혈당승고（10/179，5.59%）등。대152례환인행요추천자술，뇌척액균위무색투명，부분환인뇌척액압력승고（65/179，42.76%）、백세포계수증고（57/179，31.84%）；가반유불동정도적단백、포도당화록화물개변。경치료후，치유123례（123/179，68.72%），호전51례（51/179，28.49%），사망5례（5/179，2.79%），균사우뇌간뇌염。결론사천지구수족구병적역정발생유명현적성별、년령화계절등차이。불량적위생습관、조기비특이성적림상증상、생화학이상급뇌척액개변시수족구병합병신경계통수손적경시신호，응조기식별화치료。
Objective To investigate the epidemiological, etiological and clinical characteristics of hand, foot and mouth diseases (HFMD) complicated with nerve system damages in Sichuan area in 2012-2013. Methods Total of 179 cases of HFMD complicated with nerve system damages in our hospital from January 2012 to December 2013 were enrolled, and the epidemiological, etiological and clinical characteristics were analyzed, retrospectively. Results All the 179 cases, aged from 5 months to 6 years old, with the average age of (1.39 ± 0.34) years old, and 73.74%(132/179) of the cases were infant (≤3 years old), the ratio of male children to female ones was 1.75︰1. April to August was the peak epidemic period (132/179, 73.74%). Some cases had risk factors such as contacted with HFMD patients (48/179,26.82%), few or never washed hands before meal (56/179, 31.28%), used to suck ifngers or toys (89/179, 49.72%), et al. Early clinical manifestations were skin rash (100%), fever (169/179, 94.41%), skittishness (134/179, 74.86%), limb jitter (53/179, 29.61%), sleepness (46/179, 25.70%), vomiting (36/179, 20.11%), autism (27/179, 15.08%), convulsion (21/179, 11.73%), hydroposia bucking (6/179, 3.35%) and so on. Huamn enterovirus 71 (EV71) was the major pathogen (85/121, 70.25%). Accompanied with increased white blood cell (WBC) count (72/179, 40.22%), C-reactive protein (59/179, 32.96%), myocardium creatase (16/179, 8.94%) and serum glucose (10/179, 5.59%), and so on. There were 152 cases had lumbar puncture, and the cerebrospinal lfuid (CSF) were all colorless and transparent, accompanied with increased CSF pressure (65/179, 42.76%) and WBC count (57/179, 31.84%), or different level of proteinum, glucose and chloridate changes. After treatment, 123 patients (123/179, 68.72%) recurred, 51 patients (51/179, 28.49%) improved, and 5 cases died of brainstem encephalitis (5/179, 2.79%). Conclusions The occurrence of HFMD was different among sexes, ages and seasons in Sichuan area. Infaust health habit, nonspeciifc clinical manifestations, biochemics abnormality and cerebrospinal lfuid changes were the early signs of HFMD with nerve system damages, and should be identiifed in time for early therapy.