Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease
Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease
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DOI：
10.1016/s0140-6736(99)04434-7
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发表时间：
1999-11-13
期刊：
影响因子：
168.9
通讯作者：
Lee, CY
中科院分区：
文献类型：
--
作者：
Chang, LY;Lin, TY;Lee, CY
背景1998年4月至7月，台湾发生与肠病毒71型（EV71）相关的手足口病流行，并发致命并发症。我们在台湾对ev71相关疾病进行了临床研究。方法对154例经病毒培养证实的EV71型感染患儿进行分析。将患儿分为3组：肺水肿组11例；中枢神经系统（CNS）受累38例，无肺水肿；105个孩子没有并发症。我们比较了这三组患者的临床特征、实验室结果、危险因素和预后。结果肺水肿患儿手足口病9例，疱疹性咽峡炎1例，发热性疾病1例，肢体无力8例，肢体感觉亢进1例。所有患儿均在发病后1-3天突然出现心动过速、呼吸急促和发绀。11例患儿中有9例在插管后12小时内死亡；1例患儿在15小时内脑死亡，插管后17天死亡；其中一名儿童处于深度昏迷状态，3个月后死亡。在伴有中枢神经系统并发症且无肺水肿的儿童中，1名儿童在呼吸机支持4个月后死于肺炎，4名儿童有后遗症。105例患儿全部康复，无并发症。中枢神经系统受累与肺水肿之间存在显著关联（优势比12.4 [95% CI 2.6-60.1], p = 0.001）。中枢神经系统受累后肺水肿的危险因素是高血糖、白细胞增多和肢体无力。高血糖是肺水肿最重要的预后因素（优势比21.5 [3-159],p = 0.003）。EV71可引起手部。手足口病，中枢神经系统受累伴严重后遗症，致命性肺水肿。高血糖是最重要的预后因素。
Background In Taiwan, from April to July, 1998, an epidemic of hand, foot, and mouth disease associated with enterovirus 71 (EV71) occurred with fatal complications. We did a clinical study of EV71-related diseases in Taiwan.Methods We studied 154 children with virus-culture-confirmed EV71 infection. Children were divided into three groups: 11 patients with pulmonary oedema; 38 patients with central nervous system (CNS) involvement and no pulmonary oedema; and 105 children without complications. We compared the clinical features, laboratory findings, risk factors, and outcome among these three groups.Findings Nine children with pulmonary oedema had hand, foot, and mouth disease, one had herpangina, and one had febrile illness with eight children with limb weakness and one with limb hypesthesia. All children had had sudden onset of tachycardia, tachypnoea, and cyanosis 1-3 days after onset of the disease. Nine of 11 children died within 12 h of intubation; one child was braindead within 15 h and died 17 days after intubation; one child was in deep coma and died 3 months later. In children with CNS complication and no pulmonary oedema, one child died of pneumonia after 4 months of ventilator support and four children had sequelae. All 105 children without complications recovered. There was a significant association between CNS involvement and pulmonary oedema (odds ratio 12 4 [95% CI 2.6-60.1], p = 0.001). Risk factors for pulmonary oedema after CNS involvement were hyperglycaemia, leucocytosis, and limb weakness. Hyperglycaemia was tbe most significant prognostic factor for pulmonary oedema (odds ratio 21.5 [3-159], p = 0.003).Interpretation EV71 can cause hand. foot, and mouth disease, CNS involvement with severe sequelae, and fatal pulmonary oedema. Hyperglycaemia is the most important prognostic factor.