A Case Analysis Of 258 Children With Hand,Foot And Mouth Disease

Objective:This research is planned to analyze the cases with severe and ordinary hand,foot and mouth disease(HFMD)on epidemiology,clinical features and laboratory examination results,explore the pathogenic characterics and severe risk factors of blood biochemical examination,provide theory basis for early identification and intervention treatment of severe HFMD,reduce the mortality rate,reduce the sequela and improve the cure rate.Methods:258 cases diagnosed as HFMD from January 1,2013 to December 31,2015 in infectious disease department of Sanmenxia central hospital are selected as the research objects,including 67 cases with severe HFMD,191 cases with ordinary HFMD,and they are analyzed retrospectively with the epidemiology,clinical features and laboratory examination.Chi-square test and T-test are used for analysis to compare the different features between the two groups of children with HFMD,and Logistic regression is used to analyze the severe risk factors of blood biochemical examination.Results:1.Children who have HFMD are concentrated from April to July.The ratio of male to female with HFMD is about 1.46 to 1(153:105),and there is no statistical difference between the gender constitute of the two groups(P>0.05).Children with the highest incidence of HFMD are aged from one to three years old(66.7%,172/258),and there is no significant difference between the age of the two groups(P>0.05).There are more children living in rural than urban,and there is no significant difference between the regional characteristic of the two groups(P>0.05).The number of scattered children is more than childcare children,and there is no significant difference between the region distributed characteristic of the two groups(P>0.05).The vast majority of children have no definite contact history of HFMD,and there is no significant difference between the history of contact of the two groups(P>0.05).2.The group of severe HFMD is mainly on moderate degree of heat and high fever,and the group of ordinary HFMD is mainly on moderate degree of heat and low heat.There is no significant difference between the temperature of the two groups in pre-hospital(P>0.05),and there is statistical significant difference between the thermal process in pre-hospital of the two groups(P<0.05).Four parts with hand,foot,hip and mouth,three parts with hand,foot,and mouth,two parts with hand and foot are seen mostly in turn in the two groups of children with skin rash distribution type.Hand,foot,mouth and hip are the parts with rash most often affected in turn.The most common rash in a single area of skin is hand,followed by mouth,foot and hip.There is no significant difference between the two groups of children with skin rash distributed parts and parts number(P>0.05),and there is statistical significant difference between the time of rash appeared in pre-hospital(P<0.05).Fever and rash often appear at the same time,and there is no significant difference between the temporal relationship when fever and rash occurred(P>0.05).The manifestation of neurological involvement can be seen in all the 67 cases of severe HFMD to some extent.There is statistical significant difference between the symptoms of neurological involvement of the two groups(P<0.05).There is no significant difference between the two groups with the symptom of cough,or runny nose,abdominal pain or diarrhea,and so on(P>0.05),and there is statistical significant difference between the two groups with poor appetite and persistent fever(P<0.05).3.There is no significant difference between the two groups with white blood cell count,red blood cell count,platelet count,hemoglobin,liver function(ALT,AST,GGT),myocardial enzymes(CK,CK-MB,LDH,α-HBDH),renal function(Urea,CRE)and serum electrolyte(Ca2+)(P>0.05).There is statistical significant difference between the two groups with CRP,blood glucose and serum electrolyte(K+,Na+,Cl-),(P<0.05).There is no significant difference between the two groups with the test results and group comparison of EV71-RNA(P>0.05),and there is statistical significant difference between the results of urine ketone body of the two groups(P<0.05).In this research,85 cases of children with HFMD are tested the cerebrospinal fluid routine and biochemical detection,including 60 cases with severe HFMD,25 cases with ordinary HFMD.There is statistical significant difference between the two groups with the results of cerebrospinal fluid white blood cell count,CSF-P,Pandy test(P<0.05),and there is no significant difference between the two groups with CSF-GLU,CSF-CL,ADA(P>0.05).4.There is statistical significant difference between the two groups with CRP,CK,GGT and Na+of blood biochemical examination from the single-factor analysis results of Logistic regression(P<0.05).It is observed that CRP increased(OR = 2.863,P < 0.05)and GGT decreased(OR = 2.040,P < 0.05)are risk factors of HFMD,and CK increased(OR=0.386,P<0.05)is the protection factor from the results of multi-factor analysis.Conclusions:1.The vast majority of children have no definite contact history of HFMD,and often occur the symptoms of fever and rash at the same time.Children with severe HFMD always have longer time when fever and rash appeared in pre-hospital,and may don’t have a high level of fever and obvious increase of white blood cell count.2.CRP increased and GGT decreased are risk factors of HFMD,and CK increased is the protection factor.