2023 年第 8 期 第 18 卷

儿童医院2012—2021年重症手足口病病原体变迁及临床特征研究

Study on the pathogenic changes and clinical characteristics of severe hand-feet-mouth disease in children′s hospital from 2012 to 2021

作者：王大利1张建琴2张凤华3

英文作者：Wang Dali1 Zhang Jianqin2 Zhang Fenghua3

单位：1上海健康医学院协同科研中心，上海201318；2辽宁省大连市妇女儿童医疗中心（集团）儿童院区呼吸科，大连116012；3上海健康医学院附属周浦医院检验科，上海201318

英文单位：1Collaborative Scientific Research Center Shanghai University of Medicine ＆ Health Sciences Shanghai 201318 China; 2Department of Respiratory Children′s Hospital Area of Dalian Municipal Women and Children′s Medical Center(Group) Liaoning Province Dalian 116012 China; 3Department of Clinical Laboratory Zhoupu Hospital Shanghai University of Medicine & Health Sciences Shanghai 201318 China

关键词：重症手足口病；病原体；临床特征

英文关键词：Severehand-feet-mouthdisease;Pathogen;Clinicalcharacteristics

• 摘要：

• 目的 分析儿童医院重症手足口病病原谱及其变迁规律，了解此类患者临床特征。方法 收集2012年1月至2021年12月辽宁省大连市妇女儿童医疗中心（集团）儿童院区665例住院重症手足口病患儿的临床资料行回顾性分析。统计重症手足口病一般发生状况、不同年份发生率、月份分布、病原谱［肠道病毒通用型（EV）、肠道病毒A组71型（EV71）、柯萨奇病毒A组16型（CoxV-A16）、CoxV-A10和CoxV-A6等］、病原体变迁情况及临床特征。结果 重症手足口病男性重症率高于女性［1.0%（409/40 918）比0.9%（256/30 075）］，差异有统计学意义（P<0.05）。重症手足口病发病有明显的季节性，每年7—8月为发病高峰季节。2012—2021年665例重症手足口病患儿粪便标本检出病原体种类有EV、EV71、CoxV-A16、CoxV-A10、CoxV-A6和其他病原体；其中EV共194例、占比29.2%，EV71共130例、占比19.6%。不同时间流行优势病原体不同，2012、2013和2014年为EV71和EV，2015年为EV和CoxV-A16，2016—2018年为EV和CoxV-A6，2019年为EV、CoxV-A16和CoxV-A6，2020年为EV、CoxV-A10和CoxV-A6，2021年为EV和CoxV-A10。2012—2013年重症患儿主要表现为神经系统症状，2014—2021年多以循环系统症状为主；神经系统症状主要表现为呕吐、头痛、肢体抖动、嗜睡和抽搐。循环系统症状主要表现为心率加快、呼吸加快、发绀和血压异常。结论 儿童医院手足口病病原体复杂、呈多样性，优势病原体可发生变迁，未知亚型占比也有变化。重症病例临床可出现重要器官及多系统损害。

• Objective To analyze the pathogen spectrum and its changes of severe hand-feet-mouth disease (HFMD) in children′s hospital from 2012 to 2021, and to understand the clinical characteristics of such patients. Methods  A retrospective analysis was conducted on the clinical data of 665 hospitalized children with severe HFMD at Children′s Hospital Area of Dalian Municipal Women and Children′s Medical Center(Group), Liaoning Province from January 2012 to December 2021. The general incidence, incidence in different years, seasonal distribution, pathogen spectrum ［enterovirus general-purpose(EV), enterovirus group A 71(EV71), Coxsackievirus group A 16(CoxV-A16), CoxV-A10, and CoxV-A6］, pathogen changes, and clinical characteristics of severe HFMD were analyzed. Results The severity rate of severe HFMD in males was higher than that in females ［1.0%（409/40 918） vs 0.9%（256/30 075）］(P<0.05). The incidence of severe HFMD has a clear seasonal pattern, with the peak season from July to August every year. From 2012 to 2021, totally 665 children with severe HFMD were found to have fecal specimens containing EV, EV71, CoxV-A16, CoxV-A10, CoxV-A6, and other pathogens; among them, there were 194 cases of EV, accounting for 29.2%, and 130 cases of EV71, accounting for 19.6%. The dominant pathogens of the epidemic varied at different times, with EV71 and EV in 2012, 2013 and 2014, EV and CoxV-A16 in 2015, EV and CoxV-A6 in 2016 to 2018, EV, CoxV-A16 and CoxV-A6 in 2019, EV, CoxV-A10 and CoxV-A6 in 2020, EV and CoxV-A10 in 2021. From 2012 to 2013, severe pediatric patients mainly exhibited neurological symptoms, while from 2014 to 2021, circulatory symptoms were the main symptoms; the main symptoms of the nervous system include vomiting, headache, limb tremors, drowsiness, and convulsions. The main symptoms of the circulatory system were increased heart rate, increased breathing, cyanosis, and abnormal blood pressure. Conclusions    The pathogens of HFMD in children′s hospital were complex and varied. The dominant pathogens could change, and the proportion of unknown subtypes also changed. There may be clinical damage to vital organs and multiple systems in severe cases.