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目的了解手足口病(HFMD)儿童病例中肠道病毒71型(EV71)和柯萨奇病毒A组16型(CA16)的感染状况及重症HFMD病例的临床特征和实验室检查结果。方法采集HFMD患儿咽拭子标本,检测EV71和CA16感染情况,分析患儿性别、年龄分布情况并对重症患儿的临床特征和实验室检查结果进行回顾性分析。结果 1073例HFMD患儿中EV71阳性494例(46.04%),CA16阳性97例(9.04%),EV71阳性检出率明显高于CA16(P=0.001)。494例EV71阳性患儿中,男299例(60.53%),女195例(39.47%);97例CA16阳性患儿中,男59例(60.82%),女38例(39.18%),男性患儿构成比显著高于女性。EV71或CA16阳性患儿中“1～<2岁”组和“2～<3岁”组构成比明显高于其他年龄组。本组重症病例62例,其中重型50例(80.65%),危重型12例(19.35%)。前者以神经系统表现为主,循环系统、呼吸系统轻度受累,无死亡病例;后者并发神经系统、循环系统、呼吸系统等多器官功能损害,5例死亡。结论 2010年北京地区HFMD流行的病原体的优势株可能为EV71;男性患儿高于女性,1～3岁儿童为易感人群。危重型可引起死亡,实验室指标的变化对协助诊断重型HFMD及提示重型向危重型进展有一定意义。
Objective To investigate the infection status of enterovirus 71 (EV71) and Coxsackievirus A group 16 (CA16) in children with HFMD and the clinical features and laboratory findings of severe HFMD. Methods Throat swab specimens from children with HFMD were collected to detect the infection of EV71 and CA16. The gender and age distribution of the children were analyzed. The clinical features and laboratory findings in severe cases were analyzed retrospectively. Results Among 1073 HFMD children, 494 (46.04%) were positive for EV71 and 97 (9.04%) for CA16. The positive rate of EV71 was significantly higher than that of CA16 (P = 0.001). Among 494 EV71-positive children, 299 were male (60.53%) and 195 were female (39.47%). Among 97 CA16 positive children, 59 were male (60.82%) and 38 were female (39.18%), Children constitute significantly higher than women. In EV71 or CA16-positive children, the constitutional ratios of “1 ~ <2 years old” group and “2 ~ <3 years old” group were significantly higher than those of other age groups. The group of 62 cases of severe cases, of which 50 cases of heavy (80.65%), 12 cases of critical (19.35%). The former mainly manifested in the nervous system, circulatory system, mild respiratory involvement, no deaths; the latter complicated by nervous system, circulatory system, respiratory system and other organ damage, 5 patients died. Conclusion The predominant strains of pathogens that are endemic to HFMD in Beijing in 2010 may be EV71. The prevalence of HFMD is higher in males than in females and children 1-3 years of age are predisposed. Critical type can cause death, laboratory changes in the index to help diagnose severe HFMD and remind heavy to critical progress.