Abstract:

Abstract：Objective　To study the clinical features of hand-foot-mouth disease （HFMD） caused by enterovirus 71 （EV71） infection. Methods Clinical data of hospitalized children with hand-foot-mouth disease caused by EV71 infection from May 2010 to August 2010 were analyzed retrospectively. The difference of clinical manifestation and results of auxiliary examination between intensive HFMD group and serious HFMD group were compared. Results　High fever and nontypical skin rash showed significant difference between intensive group and serious group（P = 0.002，P = 0.000，respectively）； 120 EV71-positived HFMD cases （99.17%） showed neurological impairments. The major neurological features included fatigue （84.30%），frequent vomiting （65.30%），limb tremble （60.33%） and sleep disorders （53.72%）. The rate of abnormal knee reflex was 52.07% in physical examination. The incidence of vomiting（P = 0.001），unconsciousness （P = 0.000），abnormal muscular tension（P = 0.000），abnormal heart rate （P = 0.000），dysarteriotony （P = 0.000），capillary refill time being more than 3 seconds （CRT > 3 s） （P = 0.000），tachypnea or dyspnea （P = 0.000） and pulmonary exudative lesion in chest X-ray （P = 0.000） was morefrequent in serious group compared with intensive group，There were 51 cases （42.15% ） with a peripheral blood WBC count of more than 12 × 109/L or less than 4×109/L，52 cases （42.98% ） with blood glucose level of more than 6 mmol/L and cardiac troponin I elevated in 22 cases （18.18%）. The above three indexes were significantly different between two groups （P < 0.000，respectively）. Conclusion　HFMD caused by EV71 infection often shows neurological impairments. High fever，nontypical skin rash，frequent vomiting，unconsciousness，abnormal muscular tension，abnormal heart rate，dysarteriotony，CRT > 3s，tachypnea or dyspnea，and pulmonary exudative lesion are risk factors of serious HFMD. Early identification and correct treatment are the key to the rescue of serious HFMD.

Key words: enterovirus 71, hand-foot-mouth disease, child, neurogenic pulmonary edema

摘要：

摘要：目的　 分析肠道病毒71型（EV71）感染所致手足口病的临床特征。方法　回顾性分析2010 - 05 - 01—2010 - 08 - 31日温州医学院附属育英儿童医院121例EV71感染所致手足口病的住院患儿病例资料。比较重型组和危重型组的临床表现及辅助检查资料。 结果（1）危重型组较重型组患儿高热明显（P = 0.002）、皮疹不典型（P = 0.000）；（2）120例（99.17%）EV71阳性患儿累及神经系统，主要表现有萎靡（84.30%）、频繁呕吐（65.30%）、肢体抖动（60.33%）和睡眠障碍（53.72%）、查体发现膝反射异常（52.07%）；（3）危重型组呕吐、神志不清、肌张力异常、心率异常、血压异常、毛细血管充盈时间（CRT） > 3 s、呼吸急促或呼吸困难、胸片提示有肺部渗出性病变的发生率显著高于重型组（P < 0.01）；（4）51例（42.15%）患儿外周血白细胞总数（WBC） > 12 ×109/L或者 < 4×109/L；52例（42.98%）患儿血糖 > 6 mmol/L，22例（18.18%）肌钙蛋白-I（cTnI）升高，危重型组的这3项指标与重型组比较差异均有统计学意义（P = 0.000）。 结论 EV71感染所致手足口病多累及神经系统，高热、皮疹不典型、频繁呕吐、神志改变、肌张力异常、心率异常、血压异常、毛细血管充盈时间（CRT） > 3 s、呼吸急促或呼吸困难及肺部渗出性病变是手足口病重型患儿进展为危重型的高危因素。

关键词: 肠道病毒71型, 手足口病, 儿童, 神经源性肺水肿