珠海市0～6岁儿童手足口病调查分析
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摘要
目的探讨珠海市0~6岁儿童手足口病发病情况,为珠海市手足口病的防控提供科学依据。方法以整群随机抽样法选取2015年5月至2017年10月珠海市2456例0~6岁手足口病患儿为研究对象,采集受检者新鲜粪便进行肠道病毒检测,采集空腹静脉血检测T淋巴细胞和儿茶酚胺类激素以及常规生化项目。结果 2456例手足口病患儿以3岁及以下幼儿为主,占73.66%(1809/2456);男女患病比例为1.62:1;发病高峰期为夏秋季;2456例患儿中检出肠道病毒534例(21.74%),其中柯萨奇病毒A组16型(CVA16)感染52例(2.12%),肠道病毒71型(EV71)感染445例(18.12%),其他肠道病毒感染37例(1.51%)。2456例患儿中重症病例318例,普通病例2138例。重症病例的总病毒检出率及EV71病毒检出率均高于普通病例,差异有显著性(P<0.05);重症病例的CD3~+、CD3~+CD8~+、CD3~+CD4~+、CD3~+CD16~+CD25~+T细胞百分比明显低于普通病例,差异有显著性(P<0.05);普通病例的外周血去甲肾上腺素、肾上腺素、多巴胺、乳酸、血糖、天门冬氨酸氨基转移酶、肌酸激酶同工酶、乳酸脱氢酶水平均低于重症病例,差异有显著性(P<0.05)。结论珠海市0~6岁儿童手足口病以3岁及以下幼儿多见,夏秋季为好发季节,EV71是引起重症手足口病的主要病原体,临床治疗中应加以重视。重症手足口病患儿多伴有免疫功能紊乱或低下,检测与机体代谢、免疫功能相关的实验室指标,可有效反映机体在肠道病毒感染后的生理与病理变化,对防治手足口病具有重要意义。
Objective To investigate the situations of hand foot and mouth disease(HFMD) in children aged 0 to 6 in Zhuhai, and to provide basis for HFMD control measures in Zhuhai. Method 2456 HFMD children aged 0 to 6 in Zhuhai from May 2015 to October 2017 were selected by cluster random sampling. The fresh excreta of selected cases were obtained and given enterovirus detection. The fasting venous blood of selected cases were collected, and they were given T lymphocyte, catecholamine hormones and routine biochemistry test. Result The occurrence of HFMD was mainly in children aged 3 or below among 2456 cases, which accounted for 73.66%(1809/2456); The ratio of male to female was 1.62:1; The peak of onset was summer and autumn; There were 534 cases of enterovirus(21.74%) in 2456 children, including 52 cases of coxsackievirus A group 16 Strain(CVA16)(2.12%), 445 cases of enterovirus type 71(EV71)(18.12%) and 37 cases of other enterovirus(1.51%); There were 318 severe cases and 2138 normal cases in 2456 cases of children; The detection rate of EV71 and total detection rate of virus in severe cases were higher than those in normal cases(P<0.05); The levels of CD3~+, CD3~+CD8~+, CD3~+CD4~+, CD3~+CD16~+CD25~+ T cells in severe cases were higher than those in normal cases(P<0.05); The levels of norepinephrine(NE), epinephrin(E), dopamine(DA), lactic acid(LAC), glucose(Glu), aspartate aminotransferase(AST), creatine kinase MB(CKMB), lactate dehydrogenase(LDH) in normal cases were lower than those in severe cases(P<0.05). Conclusion HFMD children aged 0 to 6 in Zhuhai are mainly in children aged 3 or below, and peak of onset is in summer and autumn, EV71 is major pathogen of severe HFMD, so that is is necessary to pay attention to clinical treatment; Severe HFMD children usually have immune dysfunction or immune hypofunction, the detection of body metabolism and immune function-related indexes can effectively reflect physiological and pathological changes after enterovirus infection, which has important significance in HFMD prevention.
Objective To investigate the situations of hand foot and mouth disease(HFMD) in children aged 0 to 6 in Zhuhai, and to provide basis for HFMD control measures in Zhuhai. Method 2456 HFMD children aged 0 to 6 in Zhuhai from May 2015 to October 2017 were selected by cluster random sampling. The fresh excreta of selected cases were obtained and given enterovirus detection. The fasting venous blood of selected cases were collected, and they were given T lymphocyte, catecholamine hormones and routine biochemistry test. Result The occurrence of HFMD was mainly in children aged 3 or below among 2456 cases, which accounted for 73.66%(1809/2456); The ratio of male to female was 1.62:1; The peak of onset was summer and autumn; There were 534 cases of enterovirus(21.74%) in 2456 children, including 52 cases of coxsackievirus A group 16 Strain(CVA16)(2.12%), 445 cases of enterovirus type 71(EV71)(18.12%) and 37 cases of other enterovirus(1.51%); There were 318 severe cases and 2138 normal cases in 2456 cases of children; The detection rate of EV71 and total detection rate of virus in severe cases were higher than those in normal cases(P<0.05); The levels of CD3~+, CD3~+CD8~+, CD3~+CD4~+, CD3~+CD16~+CD25~+ T cells in severe cases were higher than those in normal cases(P<0.05); The levels of norepinephrine(NE), epinephrin(E), dopamine(DA), lactic acid(LAC), glucose(Glu), aspartate aminotransferase(AST), creatine kinase MB(CKMB), lactate dehydrogenase(LDH) in normal cases were lower than those in severe cases(P<0.05). Conclusion HFMD children aged 0 to 6 in Zhuhai are mainly in children aged 3 or below, and peak of onset is in summer and autumn, EV71 is major pathogen of severe HFMD, so that is is necessary to pay attention to clinical treatment; Severe HFMD children usually have immune dysfunction or immune hypofunction, the detection of body metabolism and immune function-related indexes can effectively reflect physiological and pathological changes after enterovirus infection, which has important significance in HFMD prevention.
引文
[1]张琴.2010-2015年天津市滨海新区手足口病流行特征和空间分布特点[J].职业与健康,2017,33(15):2105-2108.
[2]雅雪蓉,夏瑜,沈强,等.2011-2015年苏州市手足口病相关病原监测[J].中华实验和临床病毒学杂志,2017,31(2):118-120.
[3]谢瑞玉,李维春,朱磊,等.不同型肠道病毒感染手足口病儿童的病毒临床特点比较[J].中华医院感染学杂志,2017,27(11):2614-2617.
[4]王跃飞,林邦长,何哲航,等.T淋巴细胞亚群与调节性B细胞在儿童手足口病中的表达及临床意义[J].中华医院感染学杂志,2017,27(14):3319-3322.
[5]中华人民共和国卫生部.手足口病诊疗指南(2010年版)[J].国际呼吸杂志,2010,30(24):1473-1475.
[6]李斌,欧维琳.手足口病病原学及检测方法研究进展[J].中华实用儿科临床杂志,2016,31(6):477-480.
[7]张胜,王杨,高辉.手足口病常见病原体实验室检测研究进展[J].昆明医科大学学报,2016,37(1):1-4.
[8]吴爱琴.个性化护理联合健康教育在小儿手足口病感染防控教育中的应用效果观察[J].中国基层医药,2017,24(11):1745-1748.
[9]何文祥,陈光敏,朱颖.福建省2010-2015年手足口病流行情况及EV71 VP1区基因特征[J].中国热带医学,2017,17(7):694-698.
[10]杨再新.本溪2012-2015年手足口病流行病学及病原学特征分析[J].中国公共卫生,2017,33(2):321-324.
[11]余好,许少坚,任燕,等.深圳市龙华区2016年手足口病流行病学和病原学特征[J].中国热带医学,2017,17(4):402-404.
[12]毛其芬,崔大伟,杨先知,等.手足口病患儿细胞因子水平及免疫球蛋白的变化及其临床意义[J].中国微生态学杂志,2017,29(3):305-308.
[13]唐小清,邓雯文,张楠,等.2011-2015年重庆市南岸区手足口病流行病学及病原学特征分析[J].现代预防医学,2017,44(4):599-604.
[14]王军,龚地萍.重庆市万州区2009-2015年手足口病流行特征分析[J].中国儿童保健杂志,2017,25(5):522-524.
[15]薛娜,樊旭成,韩志国,等.乌鲁木齐市2015年手足口病流行特征及病原学分析[J].中国生物制品学杂志,2017,30(8):843-846.
[16]陈建华,武海卓,张勇,等.甘肃省2013-2015年手足口病流行特征及病原学分析[J].中华实验和临床病毒学杂志,2017,31(2):108-112.
[17]黄先萍,余中红,刘可心.2015-2016年德阳市儿童肠道病毒71型感染手足口病的流行病学特点及防治分析[J].中国妇幼保健,2017,32(13):2938-2940.
[18]何兮,张松,舒念,等.2011-2015年南充市高坪区手足口病疫情分析[J].预防医学情报杂志,2017,33(4):398-401.
[19]刘静雯,耿进妹,陈纯,等.2011-2015年广州市手足口病流行病学特征及病原学监测分析[J].现代预防医学,2017,44(5):772-777.
[20]王美芬,陈韬,顾涛,等.不同肠道病毒感染手足口病患儿儿茶酚胺、S-100蛋白及D-乳酸水平变化及其临床意义[J].中国全科医学,2017,20(16):1968-1972.
[2]雅雪蓉,夏瑜,沈强,等.2011-2015年苏州市手足口病相关病原监测[J].中华实验和临床病毒学杂志,2017,31(2):118-120.
[3]谢瑞玉,李维春,朱磊,等.不同型肠道病毒感染手足口病儿童的病毒临床特点比较[J].中华医院感染学杂志,2017,27(11):2614-2617.
[4]王跃飞,林邦长,何哲航,等.T淋巴细胞亚群与调节性B细胞在儿童手足口病中的表达及临床意义[J].中华医院感染学杂志,2017,27(14):3319-3322.
[5]中华人民共和国卫生部.手足口病诊疗指南(2010年版)[J].国际呼吸杂志,2010,30(24):1473-1475.
[6]李斌,欧维琳.手足口病病原学及检测方法研究进展[J].中华实用儿科临床杂志,2016,31(6):477-480.
[7]张胜,王杨,高辉.手足口病常见病原体实验室检测研究进展[J].昆明医科大学学报,2016,37(1):1-4.
[8]吴爱琴.个性化护理联合健康教育在小儿手足口病感染防控教育中的应用效果观察[J].中国基层医药,2017,24(11):1745-1748.
[9]何文祥,陈光敏,朱颖.福建省2010-2015年手足口病流行情况及EV71 VP1区基因特征[J].中国热带医学,2017,17(7):694-698.
[10]杨再新.本溪2012-2015年手足口病流行病学及病原学特征分析[J].中国公共卫生,2017,33(2):321-324.
[11]余好,许少坚,任燕,等.深圳市龙华区2016年手足口病流行病学和病原学特征[J].中国热带医学,2017,17(4):402-404.
[12]毛其芬,崔大伟,杨先知,等.手足口病患儿细胞因子水平及免疫球蛋白的变化及其临床意义[J].中国微生态学杂志,2017,29(3):305-308.
[13]唐小清,邓雯文,张楠,等.2011-2015年重庆市南岸区手足口病流行病学及病原学特征分析[J].现代预防医学,2017,44(4):599-604.
[14]王军,龚地萍.重庆市万州区2009-2015年手足口病流行特征分析[J].中国儿童保健杂志,2017,25(5):522-524.
[15]薛娜,樊旭成,韩志国,等.乌鲁木齐市2015年手足口病流行特征及病原学分析[J].中国生物制品学杂志,2017,30(8):843-846.
[16]陈建华,武海卓,张勇,等.甘肃省2013-2015年手足口病流行特征及病原学分析[J].中华实验和临床病毒学杂志,2017,31(2):108-112.
[17]黄先萍,余中红,刘可心.2015-2016年德阳市儿童肠道病毒71型感染手足口病的流行病学特点及防治分析[J].中国妇幼保健,2017,32(13):2938-2940.
[18]何兮,张松,舒念,等.2011-2015年南充市高坪区手足口病疫情分析[J].预防医学情报杂志,2017,33(4):398-401.
[19]刘静雯,耿进妹,陈纯,等.2011-2015年广州市手足口病流行病学特征及病原学监测分析[J].现代预防医学,2017,44(5):772-777.
[20]王美芬,陈韬,顾涛,等.不同肠道病毒感染手足口病患儿儿茶酚胺、S-100蛋白及D-乳酸水平变化及其临床意义[J].中国全科医学,2017,20(16):1968-1972.