CAJ | 학술논문

目的比较2012与2008年深圳市重症手足口病临床和实验特征,探讨其变化趋势.方法深圳市第三人民医院2008年及2012年共收治778例手足口病住院患儿,重点分析其中260例手足口病重症患者(2008年64例,2012年196例).通过RT-PCR检测Coxsackie A16(Cox A16,A16)及Enterovirus 71(EV71)病毒核酸,出现神经系统症状或体征者检查脑脊液常规及生化,部分患儿行头颅MRI检查,同时比较临床表现、血液生化等变化趋势.所有患者随访12个月评估再发情况.结果与2008年相比,2012年手足口病重症患者发病高峰年龄下降,＜12月龄儿童分别占2008年和2012年重症的15％和40％.两个年度重症患者均以EV71感染为主;与2008年相比,2012年EV71感染所占比率有下降趋势;重症患者手、足皮疹出疹率下降,而口腔疱疹出疹率明显增高,疱疹性咽峡炎引起的重症病例数上升;外周血白细胞计数、中性粒细胞比值及CRP水平均明显增高;但并发脑干脑炎或神经源性肺水肿的病例数略有下降.随访1年结果显示,无论EV71或Cox A16型手足口病临床治愈后均可多次再发,轻症再发率高于重症.结论深圳市手足口病从2008年暴发至2012年,发病呈上升趋势,重症手足口病病例临床表现具有一些新的特征,应引起广大医护人员重视.
목적 비교2012여2008년심수시중증수족구병림상화실험특정,탐토기변화추세.방법 심수시제삼인민의원2008년급2012년공수치778례수족구병주원환인,중점분석기중260례수족구병중증환자(2008년64례,2012년196례).통과RT-PCR검측Coxsackie A16(Cox A16,A16)급Enterovirus 71(EV71)병독핵산,출현신경계통증상혹체정자검사뇌척액상규급생화,부분환인행두로MRI검사,동시비교림상표현、혈액생화등변화추세.소유환자수방12개월평고재발정황.결과 여2008년상비,2012년수족구병중증환자발병고봉년령하강,＜12월령인동분별점2008년화2012년중증적15％화40％.량개년도중증환자균이EV71감염위주;여2008년상비,2012년EV71감염소점비솔유하강추세;중증환자수、족피진출진솔하강,이구강포진출진솔명현증고,포진성인협염인기적중증병례수상승;외주혈백세포계수、중성립세포비치급CRP수평균명현증고;단병발뇌간뇌염혹신경원성폐수종적병례수략유하강.수방1년결과현시,무론EV71혹Cox A16형수족구병림상치유후균가다차재발,경증재발솔고우중증.결론 심수시수족구병종2008년폭발지2012년,발병정상승추세,중증수족구병병례림상표현구유일사신적특정,응인기엄대의호인원중시.
Objective To characterize the clinical and laboratory features of severe hand,foot,and mouth disease (HFMD) in Shenzhen city in 2008 and 2012 and clarify the trend.Methods We collected throat or fecal swab from 260 severe HFMD patients (64 and 196 cases in 2008 and 2012 respectively) out of 778 HFMD cases from third people's hospital of Shenzhen in 2008 and 2012 and used specific RT-PCR to detect Coxsackie A16(Cox A16) and enterovirus 71 (EV71).The children with Neurological Symptoms were examined the CSF,physiology and biochemical level or head MRI,and further to compare the characterization of clinical feature and blood biochemistry.All of the severe HFMD patients were followed up for 1 year.Results Less than 12 months of severe HFMD patients accounted for 15％ and 40％ in 2008 and 2012 separately.EV71 was the dominant causative agent for severe HFMD in these two years,but the ratio of patient caused by EV71 was decline in 2012.Compared with 2008,in 2012,there are more rashes on the month and less on hand and feet; the case of severe HFMD with herpangina was increased.The WBC counts,neutrophil ratio,blood glucose and the level of C-Reactive protein were obviously enhanced; the number of patients complicated with brain stem encephalitis or neurogenic pulmonary edema was decreased.The 1-year followed up revealed that recurrence HFMD was common for the children caused by EV71 or CoxA16 previously and recurrence rate was higher in mild HFMD than severe cases.Conclusions Incidence of HFMD is tended to rise from the large-scale outbreak in 2008 and More attention should be pay by medical workers due to new clinical features of severe HFMD recently.