CAJ | 학술논문

目的回顾性分析西安地区2013至2014年皮疹形态以大疱表现为特征的手足口病患儿的病原及其临床特点.方法收集2013年1月至2014年12月西安市儿童医院224例以广泛的皮肤黏膜大疱反应为特征的、临床诊断为手足口病的患儿标本,以实时荧光定量PCR法进行手足口病病毒核酸检测并分型,对其临床特点、实验室检查及后期随访进行总结分析.结果在皮疹形态以大疱改变为特点的、临床诊断为手足口病的224例患儿的标本中,柯萨奇病毒A6型(CA6)阳性207例,占92.4％,肠道病毒71型(EV71)阳性4例,占1.8％,柯萨奇病毒A16型(CA16)阳性10例,占4.5％,4例肠道病毒核酸检测均阴性.220例肠道病毒核酸阳性病例中,男130例,女90例;男女比为1.44∶1,＜5岁203例,占92.3％.血常规检查白细胞升高75例,占34.1％;超敏C反应蛋白(hsCRP)升高者200例,占90.9％;心肌酶CK-MB偏高者35例,占15.9％,肝功能检查丙氨酸转氨酶(ALT)升高者15例,占6.8％.共有187例患儿出现发热,占85.0％.所有病例均未出现脑炎、心肌炎等严重并发症.病程极期皮疹均表现为大疱或大囊泡样改变,痒感明显,伴面部斑丘疹.疱疹液吸收或破溃后出现结痂和大片脱皮,基底新出皮肤无渗出,后期随访无明显色素沉着.在后期追踪随访过程中,CA6阳性病例中有52例(25.1％)距离手足口病发病期约2～4周内出现了指(趾)甲脱落剥离症状,脱甲数量1～8个,平均4.3个,甲板由里向外脱落并伴随新甲长出,脱落后的甲床未见明显结构异常,新生甲板无增生,表面光滑度存在,无肥厚,未留其他后遗症.结论皮疹形态以大疱表现为特点的手足口病主要由CA6引起,该病原所致的以大疱表现为特点的手足口病皮疹伴明显痒感,皮疹后期可出现结痂和脱皮,部分病例可出现脱甲病.
목적 회고성분석서안지구2013지2014년피진형태이대포표현위특정적수족구병환인적병원급기림상특점.방법 수집2013년1월지2014년12월서안시인동의원224례이엄범적피부점막대포반응위특정적、림상진단위수족구병적환인표본,이실시형광정량PCR법진행수족구병병독핵산검측병분형,대기림상특점、실험실검사급후기수방진행총결분석.결과 재피진형태이대포개변위특점적、림상진단위수족구병적224례환인적표본중,가살기병독A6형(CA6)양성207례,점92.4％,장도병독71형(EV71)양성4례,점1.8％,가살기병독A16형(CA16)양성10례,점4.5％,4례장도병독핵산검측균음성.220례장도병독핵산양성병례중,남130례,녀90례;남녀비위1.44∶1,＜5세203례,점92.3％.혈상규검사백세포승고75례,점34.1％;초민C반응단백(hsCRP)승고자200례,점90.9％;심기매CK-MB편고자35례,점15.9％,간공능검사병안산전안매(ALT)승고자15례,점6.8％.공유187례환인출현발열,점85.0％.소유병례균미출현뇌염、심기염등엄중병발증.병정겁기피진균표현위대포혹대낭포양개변,양감명현,반면부반구진.포진액흡수혹파궤후출현결가화대편탈피,기저신출피부무삼출,후기수방무명현색소침착.재후기추종수방과정중,CA6양성병례중유52례(25.1％)거리수족구병발병기약2～4주내출현료지(지)갑탈락박리증상,탈갑수량1～8개,평균4.3개,갑판유리향외탈락병반수신갑장출,탈락후적갑상미견명현결구이상,신생갑판무증생,표면광활도존재,무비후,미류기타후유증.결론 피진형태이대포표현위특점적수족구병주요유CA6인기,해병원소치적이대포표현위특점적수족구병피진반명현양감,피진후기가출현결가화탈피,부분병례가출현탈갑병.
Objective To investigate the pathogenic and clinical presentation and laboratory tests of bullous rash in hand,foot and mouth disease (HFMD) in Xi'an from January 2013 to December 2014 by retrospective analysis.Method A total of 224 specimens were collected from clinically diagnosed HFMD cases who were characterized by widespread mucocutaneous bullous reactions in Xi'an Children's Hospital from January 2013 to December 2014,the identification and subtyping of the isolates were conducted with real-time fluorescent quantitative RT-PCR.A retrospective analysis was performed to analyze the clinical presentation,laboratory tests and late follow-up problems of the HFMD.Result In the clinically diagnosed HFMD cases who were characterized by widespread mucocutaneous bullous reactions,207 were caused by coxsackievirus A6 (CA6),accounting for 92.4％ of all cases with bullous,4 were caused by enterovirus 71 (EV71),accounting for 1.8％,10 were caused by coxsackievirus A16 (CA16),accounting for 4.5％;4 cases were negative for these viruses.In the cases positive for intestinal virus nucleic acid,130 were male,90 were female;male to female ratio was 1.44∶ 1,203 were ＜5 years old,accounting for 92.3％.<Leukocytosis was found in 75 cases (34.1％);high-sensitivity C-reactive protein (hsCRP) increased in 200 cases (90.9％);elevated myocardial enzyme CK-MB was found in 35 cases (15.9％),alanine aminotransferase increased in 15 cases (6.8％);187 cases had fever (85.0％).None of the cases had serious complications such as encephalitis or myocarditis.In the course of the critical phase bullous rash or large vesicle-like changes,obvious itching,and facial rash appeared.After the fluid in the bullae was absorbed or the bullae ruptured or became ulcerated,scar formation and large areas of exfoliation occurred,with no effusion on the newly formed epithelium in the base,without significant pigmentation on later followup.In the late follow up process,52 cases in CA6-positive patients (25.1％) developed onychomadesis within 2-4 weeks after onset,1 to 8 nails,an average of 4.3 fell off,new nails grew,the nail bed showed no structural abnormalities and hyperplasia after falling off,the surface was smooth,had no hypertrophy,left no sequelae.Conclusion The pathogen in HFMD characterized by widespread bullous reactions was mainly the CA6,this kind of HFMD was mainly mild type,with significant itching,later the bullae may have scar formation and skin exfoliation,in some cases onychomadesis may occur.