Clinical Features And Analysis On Neurologic Involvement With Hand,Foot And Mouth Disease

Objectives To explore the clinical characteristics of children with hand, foot and mouth disease of nervous system involvement, analysis the risk of children with hand, foot and mouth disease of nervous system involvement factors, provide a reliable basis of early prevention and treatment especially for the mental involvement children.Methods This study used a retrospective analysis of epidemiological method, Collected the children with hand, foot and mouth disease who were admitted in ningxia medical university general hospital from september 2008 to September 2013 as the research object. Dividing these children into normal group and the nervous system involvement group according to the guide(2013 edition). Comparing differences between the two groups, and using Logistic regression analysis of risk factors for neurologic involvement.Results There were 476 cases of boys, 322 cases of girls, male / female was 1.48:1, the minimum age was April, the biggest 13 years old. The total of nerve involvement were 244 cases, average age 3.72 + 1.34 years; the common group were 554 cases, the common group average age 3.52 + 1.04 years, mental involvement group and common group of children had different age distribution, who were older than the general group, the difference had statistical significance. The high incidence time of HFMD were from may to July, 450 cases of children live in the countryside, there were 348 cases of living in the city, the proportion of rural was higher than urban, the difference had statistical significance.798 cases of hand foot and mouth disease were rash, the rash mainly for herpes or maculopapular round or oval, less liquid, inflammatory flush rash around, distribution in other parts of the hand, foot and mouth herpes or ulcer, hips, knees; nervous system involvement group 21 cases had wheal kind rash that appeared repeatedly. Ocuring in the knee and other parts rate was higher than the ordinary group, the difference had statistical significance; fevering in 710 cases after admission, the heating duration from 1 to 16 days, the average(2.93 + 1.02) days, nervous system involvement group fever incidence, duration of fever was higher than that of normal group, there was statistically significant differences; The normal group with the course of disease was 3 to 17 days, the average(4.93 + 1.02) days, nervous system involvement group had long duration than the normal group, the difference had statistical significance;At the same time, nervous system involvement group also behaved limbs trembling, poor mental state, vomiting, lethargy, abnormal heart rate, prolonged CRT, blood pressure and the rapid shallow breathing and other symptoms.By laboratory examination, mental system involvement group in WBC, blood glucose, creatine kinase isoenzyme, AST, ALT and ESR abnormal rate was higher than the normal group.The spirit system involvement group in CKMB, the abnormal rate of CRP was lower than that of normal group, the difference had statistical significance; Viral detection, the positive rate of the EV71 virus was higher than the normal group, the difference had statistical significance. 798 cases of hand foot and mouth disease in children with chest X ray examination, in pulmonary infection, pulmonary edema and pulmonary hemorrhage.Nervous system involvement group was higher than that of normal group, the difference was significant. Non conditional Logistic regression analysis on 17 indexes of the basic situation, auxiliary examination index, clinical characteristics of non conditional Logistic regression nerve involvement in risk factors, results suggest that age, EV71 virus, WBC and lung imaging abnormalities were risk factors.Residential city, and prehospital treatment were protective factors.Conclusion The average age of onset in this study in children with hand, foot and mouth disease was 3.72 years old, mainly focused in 1 ~ 6 years old, the incidence focused on 5 ~ 7 month, children with nervous system involvement focused mainly in male, rural proportion. The children with nervous system involvement often showed rash,especially repeated rash and knee rash, the heat and total duration was long. The EV71 infection, vomiting, white blood cell count increasing, chest imaging study abnormalities, increased heart rate, hyperglycemia in children with hand, foot and mouth disease were risk factors for progression of the disease, urban living and admission before treatment were the protective factor.