摘要
目的探讨手足口病（handfootandmouthdisease，HFMD）合并急性弛缓性麻痹（acuteflaccidparalysis，AFP）患儿的流行病学特征、临床表现及预后。方法回顾性分析2011年6月至2014年12月唐山市妇幼保健院收治的31例HFMD合并AFP患儿的住院资料、临床随访资料。结果31例HFMD合并AFP患儿中，男16例，女15例；农村患儿29例（93．5％）；年龄3个月～9岁，3岁以下患儿27例（87．1％）。病原学检查肠道病毒71型阳性11例（35．5％），柯萨奇病毒A组16型阳性1例（3．2％），其他肠道病毒感染19例（61．3％）；患儿在起病（7．14-2．9）d出现AFP表现，1～2d进展至高峰期。以发热（100％）、皮疹（100％）、惊跳（87．1％）、肢体震颤（38．7％）为主要表现，除肢体存在AFP外，均并发病毒性脑炎（100％）。31例患儿中，20例表现为单瘫，5例为双下肢瘫，4例为双上肢瘫，2例左侧肢体偏瘫，肌力从0～4级不等。21例瘫痪患儿在AFP发生2周内开始恢复，10例在第2～3周开始恢复。病程4周时10例（83．3％）单侧下肢瘫痪、5例（62．5％）单侧上肢瘫痪、3例（60．0％）双下肢瘫痪及1例（25．O％）双上肢瘫痪患儿肌力恢复至5级。结论HFMD合并AFP多发生于3岁以下患儿，农村患儿明显多于城镇患儿，肠道病毒71型感染仍比较常见，所有病例合并脑炎，瘫痪发生在HFMD进展期，AFP可表现为单瘫、双上肢瘫、双下肢瘫或偏瘫。HFMD合并的AFP可能是可逆性病变，但恢复时间有所不同，单侧下肢瘫痪恢复较快，上肢及双侧肢体瘫痪恢复较慢。
Objective To investigate the epidemiological and clinical characteristics and prognosis of 31 children with hand foot and mouth disease （ HFMD ） complicated with acute flaccid paralysis （ AFP ）. Methods Thirty-one HFMD children complicated with AFP served as study objective, who were admitted to Tangshan Maternity and Children Health Hospital from Jun 2011 to Dec 2014. The clinical manifestations and follow-up outcomes of 31 children with HFMD followed by AFP were retrospectively reviewed. Results Participants in this study consisted of 31 children （ 16 males, 15 females, age from 3 months to 9 years） who met the criteria for HFMD with AFP. Among the 31 cases ,27 （87. 1% ）cases were less than 3 years old and 29（93.5% ） cases were from countryside. Eleven cases （ 35.5% ） were infected by enterovirus 71,1 case （3.2%） was infected with coxsackieviruses A16 and 19 cases （61.3 % ） were infected by other enterovirus- es. AFP developed（7. 1 ±2. 9） days after the onset of fever and progressed to maximum severity within 1 - 2 days. All of the cases presented with fever and skin rash,38.7% cases presented with limbs tremor and 87.1% cases presented with startle and skip. Besides AFP of limbs, 100% cases complicated with encephali- tis. Thirty-one cases showed poliomyelitis-1 ike syndrome （20 cases with one flaccid limb,5 cases with lower limbs,4 cases with upper limbs and 2 cases with left hemiplegia）. In these cases, the muscle power varied from level 0 to level 4. The muscle strengthen and muscle tone in 21 patients were recovered within 2 weeks, and the other cases showed recovery 2 to 3 weeks later. After four weeks, the muscle strengthen in 19 cases recovered to 5 level（ 10 cases with single lower limb ,5 cases with single upper limb ,3 cases with two lower limbs and 1 case with two upper limbs）. Conclusion HFMD complicated with AFP most commonly occurs in children aged less than 3 years old. The majority of cases were from countryside. Enterovirus 71 is still relatively common pathogen. All the 31 cases complicated with encephalitis. Cases clinically presented one flaccid limb, lower limbs, upper limbs and hemiplegia. AFP may be to some degree reversible in HFMD cases. In most cases described here, paralysis occurred in a single lower extremity and recovered more rapidly than those with two limbs affected or with sin~,le unoer extremity impairment.
出处
《中国小儿急救医学》
CAS
2015年第11期762-766,共5页
Chinese Pediatric Emergency Medicine
关键词
急性弛缓性麻痹
手足口病
肠道病毒
Acute flaccid paralysis
Hand foot and mouth disease
Enterovirus
作者简介
通信作者：戴秀华，E—mail：tsfydxh@163．com
