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中华实验和临床感染病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (06) : 533 -538. doi: 10.3877/cma.j.issn.1674-1358.2017.06.003

临床论著

2016年度首都医科大学附属北京地坛医院手足口病患者病原学及临床特征分析
梁璞1, 刘婷1, 刘顺爱1, 庞琳2, 芦红萍1, 闫永红1, 韩铭1, 袁晓雪1, 韩凯1, 杨松3, 成军1,()   
  1. 1. 100015 北京,首都医科大学附属北京地坛医院传染病研究所;新发突发传染病研究北京市重点实验室
    2. 100015 北京,首都医科大学附属北京地坛医院儿科
    3. 100015 北京,首都医科大学附属北京地坛医院肝病三科
  • 收稿日期:2017-03-16 出版日期:2017-12-15
  • 通信作者: 成军
  • 基金资助:
    北京市科委科技项目(No. D131100005313016); 北京市卫生系统高层次卫生技术人才培养计划(No. 2015-3-108); 国家重点研发计划"华北地区中国人类遗传资源样本库集群建设"(No. 2016YFC1201703)

Etiological and clinical features of cases with hand, foot and mouth disease in a hospital in Beijing in 2016

Pu Liang1, Ting Liu1, Shun’ai Liu1, Lin Pang2, Hongping Lu1, Yonghong Yan1, Ming Han1, Xiaoxue Yuan1, Kai Han1, Song Yang3, Jun Cheng1,()   

  1. 1. Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, 100015 Beijing, China; Beijing Key Laboratory of Emerging Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, 100015 Beijing, China
    2. The Third Department of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, 100015 Beijing, China
    3. Pediatric, Beijing Ditan Hospital, Capital Medical University, 100015 Beijing, China
  • Received:2017-03-16 Published:2017-12-15
  • Corresponding author: Jun Cheng
引用本文:

梁璞, 刘婷, 刘顺爱, 庞琳, 芦红萍, 闫永红, 韩铭, 袁晓雪, 韩凯, 杨松, 成军. 2016年度首都医科大学附属北京地坛医院手足口病患者病原学及临床特征分析[J/OL]. 中华实验和临床感染病杂志(电子版), 2017, 11(06): 533-538.

Pu Liang, Ting Liu, Shun’ai Liu, Lin Pang, Hongping Lu, Yonghong Yan, Ming Han, Xiaoxue Yuan, Kai Han, Song Yang, Jun Cheng. Etiological and clinical features of cases with hand, foot and mouth disease in a hospital in Beijing in 2016[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(06): 533-538.

目的

分析首都医科大学附属北京地坛医院2016年度手足口病患者的病原体类型及其分布特点,并结合临床资料进一步掌握不同型别病原体感染的特点,为手足口病的诊疗和预防提供指导建议。

方法

本研究共采集本院儿科137例手足口病住院患儿的咽拭子及粪便标本,提取病毒RNA后采用实时荧光定量PCR的方法对样本进行肠道病毒(EV)通用型、肠道病毒71(EV71)型、柯萨奇病毒A16(CoxA16)型核酸检测,病原学分型结果结合137例手足口病患儿的临床资料和实验室检查结果进行统计分析。

结果

2016年度本院137例手足口病患者中EV71阳性率最高(40.88%);手足口病患者主要集中出现在6~8月份(62.04%);1~2岁患病儿童最多(32.12%);EV71型阳性患者中重症病例最多,且住院天数也显著多于CoxA16、非EV71非CoxA16型阳性患者;入组手足口病患者最常见的临床症状依次为发热(96.35%),皮疹/疱疹出现在手部(93.43%)、足部(88.32%)、口/咽部(75.91%)和臀部(53.28%)和易惊(41.61%);非EV71非CoxA16型肠道病毒阳性患者较EV71阳性患者的皮疹范围更广泛,且最高体温均高于EV71组和CoxA16组患者;EV71型阳性患者更易合并脑炎。

结论

本院2016年手足口病患者主要以EV71型病毒感染为主,且EV71型手足口病更易发展为重症,应该引起高度重视;对近些年逐渐增多的非EV71非CoxA16型肠道病毒阳性病例也应密切监测,防止引起新的暴发流行。

Objective

To investigate the pathogens types and distribution features among pediatric patients with hand, foot and mouth diseases (HFMD) in Beijing Ditan Hospital, Capital Medical University in 2016, which were combined with clinical data, inorder to furtherly study the characteristics of different types of pathogens infection, and to provide guidance for the diagnosis and treatment of HFMD.

Methods

The throat swabs or fecal samples of 137 patients in Division of Pediatrics in 2016 were collected. Virus RNA was tested by real-time fluorescence quantitative (RT-PCR) kits with universal enterovirus (EV) primers, Coxsackievirus A16 (CoxA16)-specific primers and enterovirus 71 (EV71)-specific primers.

Results

The positive rate of EV71 in 137 cases with HFMD in 2016 was the highest (40.88%). Patients with HFMD mainly concentrated in 6-8 months (62.04%) among children of 1-2 years old (32.12%). The most severe cases were in EV71 positive patients, and the number of hospitalisation days were significantly more than those of CoxA16, non-EV71, non-CoxA16 enteroviruses positive patients. The clinical data of patients showed the most common clinical symptoms of HFMD patients were fever (96.35%); rash/herpes appeared in the hand (93.43%), foot (88.32%), mouth/throat (75.91%) hip (53.28%) and irritable (41.61%). Non-EV71, non-CoxA16 enteroviruses positive patients got a more extensive range of skin rashes than EV71 positive patients. The maximum body temperature of non-EV71, non-CoxA16 enteroviruses positive patients was higher than patients infected EV71 or CoxA16. And EV71 positive patients with encephalitis most easily.

Conclusions

The main prevalent type in 2016 was EV71 which was most likely to develop into severe HFMD. In recent years, the increasing number of cases with non-EV71, non-CoxA16 enteroviruses positive should be paid more attention to prevent new outbreaks.

图1 2016年1至12月份不同病毒型手足口病的分布
表1 不同年龄性别手足口病患者的病原学分布
图2 不同病原体型别患者中普通和重症病例的分布
图3 不同病院体型别患者住院天数的分布
表2 2016年本院和深圳龙华区手足口病患者病原学分布[例(%)]
表3 不同型别肠道病毒阳性和阴性患者的临床资料[例(%)]
临床资料 EV71(56例) CoxA16(21例) 非EV71非CoxA16 (38例) EV-(22例) P
皮疹分布          
  53 (94.64) 21 (100.0) 33(86.84) 21(95.45) 0.260
  53(94.64) 19(90.48) 29(76.32) 20(90.91) 0.059
  38(67.86) 19(90.48) 31(83.78) 16(72.73) 0.118
  36(64.29) 12(57.14) 16(42.11) 9(40.91) 0.107
  四肢 6(10.71) 5(23.81) 11(28.95) 6(27.27) 0.095
  0 (0.00) 0 (0.00) 2(5.26) 0(0.00) 0.172
  0 (0.00) 0 (0.00) 3(7.89) 1(4.55) 0.107
  0 (0.00) 0 (0.00) 4(10.53) 1(4.55) 0.027
  0(0.00) 0 (0.00) 7(18.420 1(4.55) 0.001
发热为第一症状 26(46.43) 4(19.05) 22(57.89) 8(36.36) 0.029
皮疹为第一症状 14(25.00) 8(38.10) 6(15.79) 7(31.82) 0.240
≥ 38℃ 56(100.00) 18(85.71) 38(100.00) 20(90.91) 0.003
≥ 38℃持续天数a 5(3.0~6.0) 2.5(2.0~4.0) 3.0(2.0~4.0) 4.5(3.0~6.0) < 0.001
最高体温(℃)a 39.1(38.95~39.50) 38.95(38.70~39.50) 39.50(39.00~40.00) 39.45(39.65~39.05) 0.005
呕吐 22(39.29) 8(38.1) 11(28.95) 8(36.36) 0.775
脑炎 32(57.14) 3(14.29) 7(18.42) 7(31.82) < 0.001
支气管炎 2(3.57) 0 (0.00) 3(7.89) 5(22.73) 0.024
惊厥 1(1.79) 7(33.33) 8(21.05) 1(4.55) < 0.001
抽搐 3(5.36) 7(33.33) 12(31.58) 2(9.09) < 0.001
易惊 30(53.57) 6(28.57) 13(34.21) 8(36.36) 0.126
肢体抖动 13(23.21) 3(14.29) 2(5.26) 4(18.18) 0.117
咳嗽 10(17.86) 0(0.00) 8(21.05) 9(40.91) 0.006
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