74例无典型皮疹的手足口病脑炎患儿临床特征分析

魏金凤; 吴素玲; 滕淑

doi:10.16766/j.cnki.issn.1674-4152.002282

74例无典型皮疹的手足口病脑炎患儿临床特征分析

doi: 10.16766/j.cnki.issn.1674-4152.002282

杭州市儿童医院儿内科，浙江杭州 310014

基金项目:

浙江省医药卫生科技计划项目面上项目 2020KY760

详细信息

通讯作者:
吴素玲，E-mail：609646114@qq.com

中图分类号: R512.5 R512.3
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- 文章访问数: 287
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- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2021-01-21
- 网络出版日期: 2022-03-03

Clinical analysis of 74 children with hand-foot-mouth disease encephalitis without typical rash

Department of Pediatric, Hangzhou Children's Hospital, Hangzhou, Zhejiang 310014, China

摘要

摘要: 目的分析无典型皮疹的手足口病脑炎患儿临床特征，以指导临床早发现、早诊治，为手足口病的防控提供参考。方法收集2018年1月—2019年12月在杭州市儿童医院住院的74例确诊手足口病脑炎但无典型皮疹患儿的临床资料，包括流行病学资料、临床表现、实验室检查结果、病原学检测结果等进行回顾性分析。结果 74例患儿发病年龄为(6.92±2.72)岁，5岁及以上占82.5%。2018年和2019年各检出42例和32例，2年间检出率比较差异无统计学意义(P>0.05)。检出月份均以6、7月份检出率最高，分别为2018年的35.7%(15/42)和42.9%(18/42)，2019年的28.1%(9/32)和37.5%(12/32)，与典型手口足病流行时间一致。患儿临床以发热、头痛、呕吐为主要表现，而无典型手、足、臀皮疹和咽峡的疱疹。其皮疹表现为稀疏、细小斑丘疹，未见疱疹，分布不典型以口周、耳颈、躯干、四肢为主，且多为单个部位，达87.8%。外周血常规及脑脊液改变符合手足口病特点，脑脊液肠道病毒通用型检测均阳性，未检出常见肠道病毒EV71和CV-A6、CV-A10、CV-A16。患儿均治愈, 未出现并发症、后遗症。结论手足口病流行季节需警惕以年长儿多见，发热、头痛、呕吐为主要表现，而无典型皮疹的手足口病脑炎，避免误诊漏诊。
- 手足口病 /
- 肠道病毒 /
- 脑炎 /
- 儿童
Abstract: Objective To analyse the clinical characteristics of hand-foot-mouth disease (HFMD) encephalitis in children without typical rash, as well as to guide the early clinical detection, diagnosis, and treatment and provide reference for its prevention and control. Methods We retrospectively analysed the clinical data of 74 children with confirmed HFMD encephalitis without typical rash admitted to Hangzhou Children's Hospital from January 2018 to December 2019, including epidemiological data, clinical manifestations, laboratory examination results, and aetiological test results. Results The mean age of the 74 patients was (6.92±2.72) years old, and 82.5% were 5 years old or older. Forty-two cases and 32 cases were examined in 2018 and 2019, respectively, and there was no significant difference in the detection rate between two years(P>0.05), the highest detection rates were found in June and July, which were 35.7% (15/42 cases) and 42.9% (18/42 cases) in 2018 and 28.1% (9/32 cases) and 37.5% (12/32 cases) in 2019, respectively, which was consistent with the epidemic time of typical HMFD prevalence. Fever, headache, and vomiting were the main clinical manifestations in this group of cases, without the typical rashes of hands, feet, and buttock and herpes in the isthmus. The rashes of the cases showed sparse and small maculopapule without herpes, and the distribution was atypical, primarily around the mouth, ear, neck, trunk, and limbs. Most of them were single site, accounting for 87.8%. Peripheral blood routine and cerebrospinal fluid changes in all cases were consistent with the characteristics of HFMD. Tests were positive for enterovirus universal type, and EV71, CV-A6, CV-A10 and CV-A16 were undetected. All cases were cured without complications or sequelae. Conclusion During the epidemic season of HFMD, HFMD encephalitis primarily manifesting as fever, headache, and vomiting in older children, without typical rash, requires increased attention to avoid misdiagnosis and missed diagnosis.
- Hand-foot-mouth disease /
- Enterovirus /
- Encephalitis /
- Children

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图 1 各年份和月份的确诊例数

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表 1 74例手足口病脑炎患儿不同WBC和CRP范围的构成比

WBC(×10⁹/L)	例数(%)	CRP(g/L)	例数(%)
≤12	56(75.7)	≤10	60(81.1)
>12~≤20	17(23.0)	>10~≤20	8(10.8)
>20	1(1.3)	>20	6(8.1)
合计	74(100.0)	合计	74(100.0)
注：WBC正常范围为(4~12)×10⁹/L；CRP正常范围为0~10 mg/L。

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表 2 74例手足口病脑炎患儿不同CSF蛋白和有核细胞范围的构成比

CSF蛋白范围(mg/L)	例数构成比(%)	CSF有核细胞(×10⁶/L)范围	例数构成比(%)
≤400	28(37.8)	≤15	8(10.8)
>400~≤800	41(55.4)	>15~≤200	53(71.6)
>800~≤1 000	4(5.4)	>200~≤1 000	11(14.9)
>1 000	1(1.4)	>1 000	2(2.7)
合计	74(100.0)	合计	74(100.0)
注：CSF为脑脊液；CSF蛋白正常范围为200~400 mg/L；有核细胞正常范围为(0~15)×10⁶/L。

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