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目的探讨2例感染EV71手足口病(HFMD)死亡病例的病理特征及其病原体的分子生物学特征。方法系统分析2例HFMD病例的临床资料及尸检病理结果,并对EV71的PCR结果进行序列分析。结果死者年龄均<3岁,病情进展快,最终出现肺水肿和肺出血死亡。尸检显示:病变主要在中枢神经系统、肺脏以及肠道。大脑及脑干可见明显充血、水肿、炎症、坏死及软化灶等,脑脊膜炎症明显;肺脏显著充血,主要为水肿和出血,肺间质及小血管周围少量炎细胞浸润;肠黏膜充血,空肠及回肠部分区域肠黏膜、黏膜下层、平滑肌层、浆膜均坏死,细胞核消失,胞质及间质溶解,肠壁变薄,肠系膜淋巴结肿大,肠系膜及肠黏膜下淋巴滤泡增生,生发中心坏死;心肌纤维细胞结构正常,心肌间质充血,心肌细胞水肿,心外膜少量炎性细胞浸润;肝、脾、肾、胰腺病理改变不明显。肠内容物及总肠道组织EV 71病毒核酸检测均为阳性。EV 71病毒全基因共7414个碱基,该2株EV71均为C4亚型。结论危重型HFMD(EV 71感染)患者神经系统、呼吸系统病变明显,严重的脑干脑炎、脑膜炎和神经源性肺水肿、肺出血是死亡的主要原因;C4亚型EV71感染的重症HFMD患儿肠道的损害亦极为显著,肠道功能保护不容忽视。
Objective To investigate the pathological features of 2 deaths from EV71 hand-foot-mouth disease (HFMD) and the molecular biological characteristics of the pathogens. Methods The clinical data of 2 HFMD cases and the autopsy results were systematically analyzed. The PCR results of EV71 were sequenced. Results The deceased were all <3 years old, the disease progressed rapidly, and eventually died of pulmonary edema and pulmonary hemorrhage. Autopsy showed: Lesions mainly in the central nervous system, lung and intestine. The brain and brain stem showed obvious congestion, edema, inflammation, necrosis and softening lesions, meningitis was obvious; lung congestion was mainly edema and bleeding, interstitial and small blood vessels around the small inflammatory cell infiltration; intestinal mucosal congestion, Jejunum and ileum in some areas of the intestinal mucosa, submucosa, smooth muscle layer, serosal necrosis, disappearance of the nucleus, cytoplasm and interstitial dissolution, thinning of the intestinal wall, mesenteric lymph nodes, mesentery and intestinal submucosal lymphoid follicular hyperplasia, germinal Heart necrosis; normal myocardial cell structure, myocardial interstitial congestion, myocardial cell edema, epicardial inflammatory cell infiltration; liver, spleen, kidney, pathological changes were not obvious. Intestinal contents and total intestinal tissue EV71 virus nucleic acid tests were positive. The EV71 virus has a total of 7414 bases of all genes, and both of the two strains of EV71 are of the C4 subtype. Conclusions Serious encephalopathy, meningitis and neurogenic pulmonary edema and pulmonary hemorrhage are the main causes of death in patients with severe HFMD (EV 71 infection). Severe HFMD Intestinal damage in children is also extremely significant, gut function protection can not be ignored.