Analysis On Etiology, Immune Function And Clinical Laboratory Characteristics Of Children With Hand,foot And Mouth Disease

Objectives To investigate the infectious status of Enterovirus 71, Coxsackievirus A16 and other universal enterovirus in children with hand, foot and mouth disease in Tangshan Maternal and Child Health Hospital; To explore the changes of immune indexes and laboratory indexes in children with different clinical types of hand,foot and mouth disease, and provide reference for clinical diagnosis and treatment.Methods 1 5095 cases of children with hand, foot and mouth disease were selected as the object of study, who were treated in infectious diseases department of our hospital from January to December in 2014.The nucleic acid of the patients specimens for Enterovirus 71, Coxsackievirus A16 and universal enteroviruses were detected by real time quantitative polymerase chain reaction. 2 96 cases of children with hand, foot and mouth disease were selected randomly as the object of study, who were hospitalized in infectious diseases department of our hospital from June to September in 2014. The object of study were divided into common group of 54 cases and severe group of 42 cases. In addition, 30 cases of healthy examination children were selected as control group. Differential cell count in peripheral blood was detected by Hematology analyzer; C-reactive protein and procalcitonin were detected by special protein analyzer; The routine biochemical items were detected with automatic biochemical analyzer; The NK cells and T lymphocytes were detected by Flow Cytometry; Catecholamine were detected by enzyme linked immunosorbent assay. All the datas were inputted Microsoft office Excel 2003, and were edited to establish a database in accordance with the requirements of SPSS13.0, and were analyzed statistically by using SPSS 13.0 software.Results 1 In 5095 cases, the enteroviruses positive rate was 60.84%. Enterovirus 71 accounted for 25.71%, Coxsackievirus A16 accounted for 18.68%, other universal enteroviruses accounted for 16.45%. 2 In 5095 samples, the enteroviruses positive rate of pharyngeal swab, feces, anal swab and herpes liquid were 54.93%, 75.74%, 82.22% and 54.93% respectively. There were statistically significant differences in the positive detection rate of enteroviruses among different specimens(χ2=222.018,P<0.05). 3 In common cases, the enteroviruses positive rate was 56.86%.The positive rate of the Enterovirus 71, Coxsackievirus A16, and the other universal enteroviruses were 20.10%, 21.27% and 15.50% respectively; In severe cases, the enteroviruses positive rate was 79.20%. The positive rate of the Enterovirus 71, Coxsackievirus A16, and the other universal enteroviruses were 51.64%, 6.68% and 20.88% respectively. Statistical analysis showed there were differences in the pathogenic composition of the severe cases and the common cases of hand,foot and mouth disease(χ2=266.513,P<0.05). 4 The proportion of T cell subsets and NK cells in severe group with hand,foot and mouth disease was decreased, and the differences were statistically significant(P<0.001 or P<0.05); The levels of serum Ig A and Ig G in severe group with hand, foot and mouth disease were decreased, the differences were statistically significant(P<0.05); There were no significant differences in serum CRP and PCT levels between the three groups(P>0.05); The white blood cell count and platelet count were increased in severe group with hand,foot and mouth disease, and the differences were statistically significant(P<0.001); The levels of Glucose, lactic acid, aspartate aminotransferase, lactate dehydrogenase and creatine kinase MB in severe group with hand, foot and mouth disease were increased, the differences were statistically significant(P<0.001 或 P<0.05);The serum levels of three kinds of catecholamine in the severe group were significantly higher than that in the normal group and the control group, the differences were statistically significant(P<0.001).Conclusions 1 Enterovirus 71 is still the main pathogen causing severe hand,foot and mouth disease. Severe hand,foot and mouth disease caused by non Enterovirus 71 and Coxsackievirus A16 is also important, which should not be ignored in clinical diagnosis and treatment. 2 The children with hand,foot and mouth disease are usually associated with low or disordered immune function. Changes or disorder in immune function is an important factor in the development of children with hand,foot and mouth disease; The presence of severe hand,foot and mouth disease caused by enterovirus infection has a more complicated immunological pathogenesis, which needs further research. 3 To a certain extent, the laboratory indexes related to the function and metabolism of the body can reflect the pathological and physiological changes of the body after the enterovirus infection, which is of great significance for the prevention, control or treatment of hand,foot and mouth disease.