手足口病伴神经系统症状85例分析

摘要

Objective To explore the clinical features and outcome of patients with hand, food and mouth disease (HFMD) with early symptoms of nervous system.Methods The clinical manifestations, laboratory data, therapeutic outcomes and etiology data of 85 hospitalized cases were analyzed, including 62 cases(72.94%) with febrile convulsion (FC) and 23 cases (27.06%) with severe symptoms in early stage (easily fright, limb shaking and somnolence).Results (1) In the FC group, there mainly were the seizures on the ifrst day of fever (1-3 time, lasting 1~10 minutes) , the consciousness were back to normal after convulsion stop, no positive pathological nerve signs, and some patients had the past medical history and family history of convulsion; In the cases with severe symptoms in early stage, easily fright, limb shaking and somnolence appeared on the 3rd~4th day after onset, and disappeared after treatment for 1-3 days. (2) There was no statistically significant difference in duration of fever and rash between two groups, all P>0.05. (3) Most of the patients had elevated blood leukocytes, C-reaction protein, sugar and hyponatremia, some have elevated myocardial enzymes and EKG abnormalities, mainly in the FC group. (4) Pathogen detection: 45 cases (52.94%)-EV71 RNA (+), 19 cases (22.35%)-CoxA16 RNA (+), 12 cases (14.12%)-general intestinal virus nucleic acid (+), 9 cases (10.59%) nucleic acid (-), and no cross positive results. (5)The average hospitalization was 5.86±1.89 day, and sequela was not found in follow-up.Conclusions It is helpful for guiding the treatment and judging the prognosis that the conditions and causes of illness are early identiifed in patients with HFMD with symptoms of nervous system.%目的：探讨手足口病伴早期神经系统症状患者的临床特征及结局。方法对85例手足口病住院病例的临床表现、实验室检查、治疗转归及病原学等资料进行分析，其中热性惊厥（FC）62例，占72.94%，HFMD重症早期（易惊、肢体抖动、嗜睡）23例，占27.06%。结果（1）FC组主要表现为在发热第一天出现1-3次抽搐，持续1-10分钟不等，发作停止后神志恢复正常，无阳性病理神经征，部分有既往史和家族惊厥史；重症早期组主要表现为病后3-4天出现易惊、肢体抖动、嗜睡，于治疗后1-3天正常，无阳性病理神经征。（2）两组发热及皮疹持续时间的差异均无明显统计学意义，P均＞0.05。（3）多数患者存在血白细胞、C反应蛋白、糖升高及低钠血症，部分有心肌酶谱升高、心电图异常，以FC组为主。（4）病原检测：EV71-RNA（+）45例（52.94%），CoxA 16-RNA（+）19例（22.35%），肠道病毒通用核酸（+）12例（14.12%），余9例（10.59%）检测均阴性，无交叉阳性结果。（5）平均住院5.86±1.89天，随访均未见后遗症。结论早期识别HFMD伴神经系统症状患者的病情及病因，有助于指导治疗及判断预后。