目的:探讨手部的临床特点,脚,和由柯萨奇病毒A6(CVA6)引起的口蹄疫(HFMD),这项工作可能有助于非典型HFMD的早期诊断。
方法:2013年1月至2019年12月,西安市儿童医院收治的临床诊断为手足口病的患者共7,208例,西安市中心医院,西安交通大学第二附属医院,被纳入这项观察性研究。临床数据,收集标本和随访结果。实时RT-PCR用于肠道病毒核酸的检测和分型。
结果:在7,208例临床诊断的手足口病患者中,5,622个肠道病毒核酸阳性,和CVA6,肠道病毒71(EV-A71)的阳性比例,柯萨奇病毒A16(CVA16),其他肠道病毒占31.0%(1,742/5,622),27.0%(1,518/5,622),35.0%(1,968/5,622),和7.0%(394/5,622),分别。根据病因,患者分为CVA6组,EV-A71组,CVA16组。CVA6组的平均发病年龄(4.62±2.13岁)明显高于EV-A71组和CVA16组(3.45±2.25岁和3.35±2.13岁,分别为;两者P<0.05)。CVA6组的男女比例为1.45(1,031/711),与其他两组无显着差异。CVA6组发热发生率[82.5%(1,437/1,742)]明显高于EV-A71组[51.3%(779/1,518)]和CVA16组[45.9%(903/1,968)](P<0.05)。在CVA6组中,躯干和肘部/膝部皮疹发生率较高,与其他两组相比差异有统计学意义(P<0.05)。CVA6组出现两种或两种以上皮疹形态的患者例数明显高于其他两组(P<0.05)。CVA6组的大疱性皮疹发生率[20.2%;n=352]高于EV-A71组[0.33%;n=5]和CVA16组[0.66%;n=13](P<0.05)。EV-A71组神经系统并发症发生率[52.1%(791/1,518)]明显高于CVA16组[5.1%(100/1,968)]和CVA6组[0.8%(14/1,742)](P<0.05)。在后续阶段,160例(9.2%)CVA6HFMD患者经历了甲癣,但在EV-A71和CVA16组中未观察到甲癣。CVA6组的平均WBC计数明显高于CVA16组(P<0.05)。CVA6组CRP升高的患者数量明显多于CVA16组,但明显少于EV-A71组(P<0.05)。
结论:CVA6已成为2013-2019年西安地区手足口病的主要病原之一。主要临床表现与EV-A71或CVA16引起的手足口病略有不同,发热频率较高,皮疹的不同形态和扩散分布,较少的神经系统并发症和一些甲癣。
OBJECTIVE: To investigate the clinical features of hand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 (CVA6) and this work may help early diagnose of atypical HFMD.
METHODS: From January 2013 to December 2019, a total of 7,208 patients with a clinical diagnosis of HFMD in Xi\'an Children\'s Hospital, Xi\'an Central Hospital, and Xi\'an Jiaotong University Second Affiliated Hospital, were included in this observational
study. The clinical data, specimens and follow-up results were collected. Real-time RT‒PCR was performed for the detection and typing of
enterovirus nucleic acids.
RESULTS: Of the 7,208 clinically diagnosed HFMD patients, 5,622 were positive for
enterovirus nucleic acids, and the positive proportions of CVA6,
enterovirus 71 (EV-A71), coxsackievirus A16 (CVA16), and other enteroviruses were 31.0% (1,742/5,622), 27.0% (1,518/5,622), 35.0% (1,968/5,622), and 7.0% (394/5,622), respectively. Based on the etiology, patients were divided into CVA6 group, EV-A71group, and CVA16 group. The mean age at onset was significantly higher in the CVA6 group (4.62±2.13 years) than in the EV-A71 group and CVA16 group (3.45±2.25 years and 3.35±2.13 years, respectively; both P < 0.05). The male/female ratio was 1.45 (1,031/711) in the CVA6 group and was not significantly different from the other two groups. The incidence of fever was significantly higher in the CVA6 group [82.5% (1,437/1,742)] than in the EV-A71 group [51.3% (779/1,518)] and the CVA16 group [45.9% (903/1,968)] (P < 0.05). In the CVA6 group, the rashes were more frequently on the trunk and elbows/knees and were significantly different from the other two groups (P < 0.05). The number of patients with two or more rash morphologies was significantly higher in the CVA6 group than in the other two groups (P < 0.05). The incidence of bullous rash in the CVA6 group [20.2%; n = 352] was higher than in the EV-A71 group [0.33%; n = 5] and CVA16 group [0.66%; n = 13] (P < 0.05). The incidence of neurological complications was significantly higher in the EV-A71 group [52.1% (791/1,518)] than in the CVA16 group [5.1% (100/1,968)] and the CVA6 group [0.8% (14/1,742)] (P < 0.05). In the follow-up period, 160 patients (9.2%) with CVA6 HFMD experienced onychomadesis, but no onychomadesis was observed in the EV-A71 and CVA16 groups. The average WBC count was significantly higher in the CVA6 group than in the CVA16 group (P < 0.05). The number of patients with increased CRP was significantly larger in the CVA6 group than in the CVA16 group but was significantly smaller than that in the EV-A71 group (P < 0.05).
CONCLUSIONS: CVA6 has become one of the main pathogens of HFMD in the Xi\'an area during 2013-2019. The main clinical manifestations were slightly different from those of HFMD caused by EV-A71 or CVA16, with a higher frequency of fever, diverse morphologies and diffuse distribution of rashes, fewer neurological complications and some onychomadesis.