人肠道病毒71型感染致重症手足口病的危险因素分析
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摘要
目的探讨肠道病毒71型感染导致重症手足口病的危险因素。方法选取2015年5月至2017年10月间我院感染科收治的EV71型手足口病患儿140例为研究对象,依据临床分期标准分为普通病例组95例和重症病例组45例,收集并比较两组患儿一般资料、临床表现、实验室指标等,采用多因素Logistics回归分析判断影响手足口病重症化的危险因素。结果两组患儿的性别、年龄、BMI间比较差异无统计学意义(P>0.05);两组患儿的ALT、AST、脑脊液葡萄糖浓度比较差异无统计学意义(P>0.05),但重症病例组的WBC [(12.65±3.51)×10~9/L vs(9.16±3.44)×10~9/L]、CRP[(10.67±4.75)mg/L vs(6.58±3.04)mg/L]、热程[(7.46±2.21)d vs(2.93±1.22)d]、热峰[(38.91±0.35)℃vs(38.34±0.45)℃]、血糖[(8.40±0.78)mmol/L vs(5.96±1.14)mmol/L]、CK-MB[(17.84±1.57)U/L vs(15.75±1.64)U/L]、NP[53.47(31.50～70.22)%vs 46.89(29.44～67.01)%]、肢体抖动(37.78%vs 9.47%)、脑脊液蛋白质浓度[319.63(211.40～463.53)mg/L vs 224.82(172.24～396.91)mg/L]、脑脊液细胞数[(18.74±5.62)×10~6/L vs(4.87±2.03)×10~6/L]均较普通病例组显著升高,脑脊液氯化物水平[(117.52±2.84)mmol/L vs(119.75±3.09)mmol/L]较普通病例组显著降低,差异有统计学意义(P<0.05);多因素Lo?gistics回归分析发现,热程延长(OR=8.812)、热峰升高(OR=682.359)、血清CRP(OR=1.920)、CK-MB水平升高(OR=6.299)以及脑脊液蛋白质浓度升高(OR=1.014)是手足口病重症化的独立危险因素(P<0.05)。结论 EV71感染手足口病重症化与患儿年龄、性别无关,与热程、热峰、CRP、CK-MB、脑脊液蛋白质浓度呈正相关,可作为判断EV71感染手足口病重症化的独立危险因素。
Objective To investigate the risk factors of severe hand foot mouth disease(HFMD) caused by enterovirus71 infection. Methods A total of 140 children with EV71 type hand foot and mouth disease in the Department of Infection in our hospital from May 2015 to October 2017 were selected as the research object, and divided into the general case group and the severe case group according to the clinical stage standard. The children's general data, clinical manifestations and laboratory indexes in the two groups were collected and compared. Multivariate logistics regression analysis was used to determine the risk factors for severe hand foot mouth disease. Results There was no significant difference in gender, age and BMI between the two groups(P>0.05).TherewasnosignificantdifferenceintheALT,ASTandglucoseconcentrationofCSFinthetwogroups(P>0.05),buttheWBC[(12.65±3.51)×10~9/L vs(9.16±3.44)×10~9/L],CRP[(10.67±4.75)mg/Lvs(6.58±3.04)mg/L],fevertime[(7.46±2.21) d vs(2.93±1.22) d], hot peak(38.91±0.35)℃ vs(38.34±0.45)℃], blood glucose[(8.40±0.78) mmol/L vs(5.96±1.14) mmol/L], CKMB [(17.84±1.57) U/L vs(15.75±1.64) U/L], NP [53.47(31.50-70.22)% vs 46.89(29.44-67.01)%], limb shaking(37.78% vs9.47%), cerebrospinal fluid protein concentration [319.63(211.40-463.53)mg/L vs 224.82(172.24-396.91) mg/L] and cerebrospinal fluid cell number [(18.74±5.62)×10~6/L vs(4.87±2.03)×10~6/L] in the severe case group were significantly higher than those of the general case group, and the level of chlorides[(117.52 ± 2.84) mmol/L vs(119.75 ± 3.09) mmol/L] in cerebrospinal fluid was significantly lower than that of the common case group(P<0.05). The multiple factor logistics regression analysis showed that the prolonged fever time(OR=8.812), the increase of hot peak(OR=682.359), the increase of serum CRP(OR=1.920), CK-MB(OR=6.299) and the increase of the concentration of cerebrospinal fluid protein(OR=1.014) were independent risk factors for the severe hand foot and mouth disease(P<0.05). Conclusion The severity of EV71 type hand foot and mouth disease is not related to the age and sex of the children. It has a positive correlation with the fever time, hot peak, CRP, CK-MB, and the protein concentration of cerebrospinal fluid, which can be used as independent risk factors to judgethe severity of EV71 type hand foot and mouth disease.
Objective To investigate the risk factors of severe hand foot mouth disease(HFMD) caused by enterovirus71 infection. Methods A total of 140 children with EV71 type hand foot and mouth disease in the Department of Infection in our hospital from May 2015 to October 2017 were selected as the research object, and divided into the general case group and the severe case group according to the clinical stage standard. The children's general data, clinical manifestations and laboratory indexes in the two groups were collected and compared. Multivariate logistics regression analysis was used to determine the risk factors for severe hand foot mouth disease. Results There was no significant difference in gender, age and BMI between the two groups(P>0.05).TherewasnosignificantdifferenceintheALT,ASTandglucoseconcentrationofCSFinthetwogroups(P>0.05),buttheWBC[(12.65±3.51)×10~9/L vs(9.16±3.44)×10~9/L],CRP[(10.67±4.75)mg/Lvs(6.58±3.04)mg/L],fevertime[(7.46±2.21) d vs(2.93±1.22) d], hot peak(38.91±0.35)℃ vs(38.34±0.45)℃], blood glucose[(8.40±0.78) mmol/L vs(5.96±1.14) mmol/L], CKMB [(17.84±1.57) U/L vs(15.75±1.64) U/L], NP [53.47(31.50-70.22)% vs 46.89(29.44-67.01)%], limb shaking(37.78% vs9.47%), cerebrospinal fluid protein concentration [319.63(211.40-463.53)mg/L vs 224.82(172.24-396.91) mg/L] and cerebrospinal fluid cell number [(18.74±5.62)×10~6/L vs(4.87±2.03)×10~6/L] in the severe case group were significantly higher than those of the general case group, and the level of chlorides[(117.52 ± 2.84) mmol/L vs(119.75 ± 3.09) mmol/L] in cerebrospinal fluid was significantly lower than that of the common case group(P<0.05). The multiple factor logistics regression analysis showed that the prolonged fever time(OR=8.812), the increase of hot peak(OR=682.359), the increase of serum CRP(OR=1.920), CK-MB(OR=6.299) and the increase of the concentration of cerebrospinal fluid protein(OR=1.014) were independent risk factors for the severe hand foot and mouth disease(P<0.05). Conclusion The severity of EV71 type hand foot and mouth disease is not related to the age and sex of the children. It has a positive correlation with the fever time, hot peak, CRP, CK-MB, and the protein concentration of cerebrospinal fluid, which can be used as independent risk factors to judgethe severity of EV71 type hand foot and mouth disease.
引文
[1]刘颖丽,纪颖,于蕾,等.手足口病流行病学及防治的研究概况[J].中国微生态学杂志, 2016, 28(12):1480-1482.
[2] WANG Z, NICHOLLS J M, LIU F, et al. Pulmonary and central nervous system pathology in fatal cases of hand foot and mouth disease caused by enterovirus A71 infection.[J]. Pathology, 2016, 48(3):267-274.
[3]吴娴波,钟艳云,曹宇娟,等.广东EV71病毒流行病学特征和毒力分析[J].实用医学杂志, 2015, 31(6):999-1002.
[4]中华人民共和国卫生部.手足口病诊疗指南(2010版)[J].中国实用乡村医生杂志, 2012, 19(19):9-11.
[5]卫生部手足口病临床专家组.肠道病毒71型(EV71)感染重症病例临床救治专家共识[J].中华儿科杂志, 2011, 49(9):675-678.
[6]武瑞青,陈丽琴,雷德明.肠道病毒Ev71感染手足口病并发神经系统损伤研究进展[J].内蒙古医科大学学报, 2015, 37(S1):113-117.
[7] YI E J, SHIN Y J, KIM J H, et al. Enterovirus 71 infection and vaccines[J]. Clin Exp Vaccine Res, 2017, 6(1):4-14.
[8] WANG S M, LIU C C, TSENG H W, et al. Clinical spectrum of enterovirus 71 infection in children in southern Taiwan, with an emphasis on neurological complications[J]. Clin Infect Dis, 1999, 29(1):184-190.
[9] LI W, TENG G, TONG H, et al. Study on risk factors for severe hand, foot and mouth disease in China[J]. PLoS One, 2014, 9(1):e87603.
[10] YAMAMOTO T, TANAKA H, EMOTO Y, et al. Carnitine palmitoyltransferase 2 gene polymorphism is a genetic risk factor for sudden unexpected death in infancy[J]. Brain Dev, 2014, 36(6):479-483.
[11] CHANG Y L, HO B C, SHER S, et al. miR-146a and miR-370 coordinate enterovirus 71-induced cell apoptosis through targeting SOS1 and GADD45β[J]. Cell Microbiol, 2015, 17(6):802-818.
[12] VOLLE R, ARCHIMBAUD C, COURAUD P O, et al. Differential permissivity of human cerebrovascular endothelial cells to enterovirus infection and specificities of serotype EV-A71 in crossing an in vitro model of the human blood-brain barrier[J]. J Gen Virol, 2015,96(7):1682-1695.
[13]章玉丹,张惠芳,李华,等. EV71病毒感染儿童重症手足口病临床危险因素分析[J].陕西医学杂志, 2017, 46(9):1172-1173.
[14] HUANG P N, SHIH S R. Update on enterovirus 71 infection[J]. Curr Opin Virol, 2014, 5(5):98-104.
[15] LU H K, LIN T Y, HSIA S H, et al. Prognostic implications of myoclonic jerk in children with enterovirus infection[J]. J Microbiol Immunol Infect, 2004, 37(2):82-87.
[2] WANG Z, NICHOLLS J M, LIU F, et al. Pulmonary and central nervous system pathology in fatal cases of hand foot and mouth disease caused by enterovirus A71 infection.[J]. Pathology, 2016, 48(3):267-274.
[3]吴娴波,钟艳云,曹宇娟,等.广东EV71病毒流行病学特征和毒力分析[J].实用医学杂志, 2015, 31(6):999-1002.
[4]中华人民共和国卫生部.手足口病诊疗指南(2010版)[J].中国实用乡村医生杂志, 2012, 19(19):9-11.
[5]卫生部手足口病临床专家组.肠道病毒71型(EV71)感染重症病例临床救治专家共识[J].中华儿科杂志, 2011, 49(9):675-678.
[6]武瑞青,陈丽琴,雷德明.肠道病毒Ev71感染手足口病并发神经系统损伤研究进展[J].内蒙古医科大学学报, 2015, 37(S1):113-117.
[7] YI E J, SHIN Y J, KIM J H, et al. Enterovirus 71 infection and vaccines[J]. Clin Exp Vaccine Res, 2017, 6(1):4-14.
[8] WANG S M, LIU C C, TSENG H W, et al. Clinical spectrum of enterovirus 71 infection in children in southern Taiwan, with an emphasis on neurological complications[J]. Clin Infect Dis, 1999, 29(1):184-190.
[9] LI W, TENG G, TONG H, et al. Study on risk factors for severe hand, foot and mouth disease in China[J]. PLoS One, 2014, 9(1):e87603.
[10] YAMAMOTO T, TANAKA H, EMOTO Y, et al. Carnitine palmitoyltransferase 2 gene polymorphism is a genetic risk factor for sudden unexpected death in infancy[J]. Brain Dev, 2014, 36(6):479-483.
[11] CHANG Y L, HO B C, SHER S, et al. miR-146a and miR-370 coordinate enterovirus 71-induced cell apoptosis through targeting SOS1 and GADD45β[J]. Cell Microbiol, 2015, 17(6):802-818.
[12] VOLLE R, ARCHIMBAUD C, COURAUD P O, et al. Differential permissivity of human cerebrovascular endothelial cells to enterovirus infection and specificities of serotype EV-A71 in crossing an in vitro model of the human blood-brain barrier[J]. J Gen Virol, 2015,96(7):1682-1695.
[13]章玉丹,张惠芳,李华,等. EV71病毒感染儿童重症手足口病临床危险因素分析[J].陕西医学杂志, 2017, 46(9):1172-1173.
[14] HUANG P N, SHIH S R. Update on enterovirus 71 infection[J]. Curr Opin Virol, 2014, 5(5):98-104.
[15] LU H K, LIN T Y, HSIA S H, et al. Prognostic implications of myoclonic jerk in children with enterovirus infection[J]. J Microbiol Immunol Infect, 2004, 37(2):82-87.