1例手足口病重症死亡病例的尸检病理观察
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摘要
目的观察手足口病死亡病例组织器官病理变化,探讨病理发生机制,为临床诊断、治疗和预防提供科学依据。方法采集手足口病死亡病例组织、胸腔积液和粪便等标本,实时荧光RT-PCR检测胸腔积液和粪便标本中手足口病病原核酸,并进一步分离病毒,进行基因组测序和序列分析,并对组织标本进行HE染色病理学检查。结果胸腔积液和粪便标本EV71病毒核酸检测阳性,细胞培养分离到5株EV71毒株,基因型为C4基因亚型;病理组织学检查发现肺、肾脏、胸髓和肝脏组织病理变化。结论 EV71病毒感染是引起手足口病患者死亡的主要原因。
Objective To explore the pathogenesis of hand foot and mouth disease by observing the pathological changes of tissues and organs of the death case of severe hand foot and mouth disease,so as to provide scientific basis for clinical diagnosis,treatment and prevention. Methods Tissue,pleural effusion and stool samples of the death case of severe hand foot and mouth disease were collected,and pathogenic nucleic acid was detected using real-time RT-PCR,followed by isolation of the virus,genome sequencing and sequence analysis, HE staining,pathological examination. Results EV71 virus nucleic acid in pleural effusion and stool samples was positive,and 5 strains of were isolated by cell culture, and the genotype was C4. The pathological changes of lung, kidney, thoracic spinal cord and liver were observed by histopathological examination.Conclusion EV71 infection is the leading cause of death in patients with hand foot and mouth disease.
Objective To explore the pathogenesis of hand foot and mouth disease by observing the pathological changes of tissues and organs of the death case of severe hand foot and mouth disease,so as to provide scientific basis for clinical diagnosis,treatment and prevention. Methods Tissue,pleural effusion and stool samples of the death case of severe hand foot and mouth disease were collected,and pathogenic nucleic acid was detected using real-time RT-PCR,followed by isolation of the virus,genome sequencing and sequence analysis, HE staining,pathological examination. Results EV71 virus nucleic acid in pleural effusion and stool samples was positive,and 5 strains of were isolated by cell culture, and the genotype was C4. The pathological changes of lung, kidney, thoracic spinal cord and liver were observed by histopathological examination.Conclusion EV71 infection is the leading cause of death in patients with hand foot and mouth disease.
引文
[1]马红霞,潘静静,李懿,等.合并神经症状的手足口病病原学和流行病学特征[J].中华微生物学和免疫学杂志,2016,36(11):851-854.
[2]郑亚明,杨娟,廖巧红.中国6月龄至5岁以下手足口病重症病例直接医疗费用情况及其影响因素[J].中华预防医学杂志,2017,51(1):87-92.
[3]Yan J J,Su I J,Chen P F,et al.Complete genome analysis of enterovirus 71 isolated from an outbreak in Taiwan and rapid identification of enterovirus 71 and coxsackievirus A16 by RT-PCR[J].J Med Virol,2001,65(2):331-339.
[4]Pérez-Vélez C M,Anderson M S,Robinson C C,et al.Outbreak of neurologic enterovirus type 71 disease:a diagnostic challenge[J].Clin Infect Dis,2007,45(8):950-957.
[5]黄学勇,康锴,许玉玲,等.2008—2011年河南省手足口病患儿病原学监测结果[J].中华预防医学杂志,2012,46(10):883-887.
[6]隋吉林,王子军.635例手足口病死亡病例流行病学及临床特征分析[J].中华流行病学杂志,2012,33(11):1201-1202.
[7]蒙国照,李美琼,李运千,等.危重型手足口病3例尸检临床病理分析[J].临床与实验病理学杂志,2011,27(1):48-51,55.
[2]郑亚明,杨娟,廖巧红.中国6月龄至5岁以下手足口病重症病例直接医疗费用情况及其影响因素[J].中华预防医学杂志,2017,51(1):87-92.
[3]Yan J J,Su I J,Chen P F,et al.Complete genome analysis of enterovirus 71 isolated from an outbreak in Taiwan and rapid identification of enterovirus 71 and coxsackievirus A16 by RT-PCR[J].J Med Virol,2001,65(2):331-339.
[4]Pérez-Vélez C M,Anderson M S,Robinson C C,et al.Outbreak of neurologic enterovirus type 71 disease:a diagnostic challenge[J].Clin Infect Dis,2007,45(8):950-957.
[5]黄学勇,康锴,许玉玲,等.2008—2011年河南省手足口病患儿病原学监测结果[J].中华预防医学杂志,2012,46(10):883-887.
[6]隋吉林,王子军.635例手足口病死亡病例流行病学及临床特征分析[J].中华流行病学杂志,2012,33(11):1201-1202.
[7]蒙国照,李美琼,李运千,等.危重型手足口病3例尸检临床病理分析[J].临床与实验病理学杂志,2011,27(1):48-51,55.