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目的了解近年来危重型手足口病(HFMD)患儿临床特征及变化,为临床诊断与治疗提供依据。方法收集36例危重型HFMD患儿临床资料,包括年龄、性别、症状、体征、实验室检查及临床转归情况。结果 36例患儿中男22例,女14例,男女比例1.57:1,3岁以内患儿33例(91.67%),5～7月份发病23例(63.89%),城乡比例为1:8。表现为皮疹36例(100%)、发热35例(97.22%)、肺部啰音30例(83.33%)、呕吐27例(75.00%)、肢体抖动17例(47.22%)、Babinski征阳性17例(47.22%)、休克13例(36.11%)。34例(94.44%)为肠道病毒71型(EV71)感染,18例合并流感病毒感染,23例血白细胞升高,24例出现高血糖,15例合并腺病毒感染。19例死亡病例中13例出现高血糖,13例血白细胞升高。结论 3岁以内婴幼儿为危重型HFMD病高危人群,5～7月为高峰季节。EV71感染是危重型手足口病的主要病原;外周血白细胞升高、高血糖是预测病情进展及预后的主要危险因素,应引起高度重视。EV71合并流感病毒感染、腺病毒感染可能是导致手足口病病情加重的危险因素。
Objective To understand the clinical features and changes of critically ill hand-foot-mouth disease (HFMD) in recent years and provide the basis for clinical diagnosis and treatment. Methods The clinical data of 36 critically ill children with HFMD were collected, including age, sex, symptoms, signs, laboratory tests and clinical outcomes. Results There were 22 males and 14 females in 36 cases. The ratio of males to females was 1.57: 33 cases (91.67%) were within 1 year, 23 cases (63.89%) in May to July, and the ratio of urban area to rural area was 1: 8 . There were 36 cases (100%) of rash, 35 cases of fever (97.22%), 30 cases of pulmonary rales (83.33%), 27 cases of vomiting (75.00%), 17 cases of limb jitter (47.22% Cases (47.22%), shock in 13 cases (36.11%). 34 cases (94.44%) were infected with enterovirus 71 (EV71), 18 with influenza virus infection, 23 with leukocytosis, 24 with hyperglycemia and 15 with adenovirus infection. Thirteen of the 19 deaths showed hyperglycemia and 13 had leukocytosis. Conclusion Infants and young children within 3 years of age are at high risk for critically ill HFMD and peak season from May to July. EV71 infection is the major pathogen of critically ill hand-foot-mouth disease. The increase of peripheral white blood cells and hyperglycemia are the main risk factors for predicting the progression and prognosis of the disease. EV71 infection with influenza virus infection, adenovirus infection may be the risk factor for HFMD exacerbations.