探讨重症手足口病(HFMD)合并急性迟缓性瘫痪(AFP)的临床特点及病原学分析。

选择2008年4月至2011年7月在昆明市儿童医院住院治疗的2500例重症HFMD中合并AFP的32例患儿为研究对象。其相关实验室检查包括血常规、生化常规、心电图、脑电图、头颅CT及脑脊液(CSF)检查等，并对其进行大便病原学检测及分型。

本组重症HFMD合并AFP患儿的发生率为1.3%(32/2500)。其中，<3岁患儿为30例(93.8%)。31例患儿大便送检结果示肠道病毒(EV) 71型呈阳性为27例(87.1%)。32例HFMD合并AFP患儿均合并发热，手、足皮疹及口腔疱疹等典型HFMD临床症状，在病程中患儿出现精神差，呕吐，抽搐，肢体抖动，心率、呼吸增快等神经系统症状，脑电图出现慢波，CSF出现白细胞(WBC)计数及蛋白升高，血常规示WBC计数及中性粒细胞明显升高，合并脑炎、脑脊髓炎、迟缓性麻痹、肺水肿、循环衰竭等临床症状。本组2例患儿因入院时病情危重，死于神经源性肺水肿及肺出血。

重症HFMD合并AFP多发生于<3岁幼儿，病原体主要为EV71。对其早期应用激素、静脉丙种球蛋白等治疗，可减少HFMD导致的并发症及后遗症。

To investigate clinical features and etiology of severe hand-foot and mouth disease(HFMD)children combined with acute flaccid paralysis(AFP).

This was a prospective observational study with institutional ethics approval and written parents of each child consent. A total of 32 children of severe HFMD with AFP in 2500 severe HFMD who hospitalized from April 2008 to July 2011 in Children's Hospital of Kunming were recruited.Lab tests including blood routine test, routine biochemical analysis, electrocardiogram, electroencephalogram, CT scan of the brain and examination of the cerebrospinal fluid(CSF) and so on, and stool samples collected from severe HFMD with AFP children were also processed for detection of etiological features and types.

The incidence rate of severe HFMD with AFP in severe HFMD was 1.3%(32/2500). All of 30 (93.8%) out of 32 cases of severe HFMD with AFP children were less than 3 years old, 27(87.1%) out of 31 cases were EV71RNA positive by tests of stool samples, early signs and symptoms of severe HFMD with AFP included fever, rashes on hands and feet, herpes of mouth, sores in the mouth, and a rash with blisters, severe neurological complications and tachypnea, electroencephalogram had slow mode wave, white blood cell (WBC) count and protein increased in CSF, WBC count and neutrophil increased significantly in blood routine test, all cases had encephalitis, encephalomyelitis, flaccid paralysis, pneumonedema and circulatory collapse etc.. Death of neurogenic pulmonary edema and pulmonary hemorrhage had 2 cases presenting in a critical condition during admission.

Severe HFMD with AFP occurred more often in children less than 3 years old, EV 71 was the major etiological agent.It was necessary to treatment by lucocorticoid and intravenous immunoglobulin as soon as possible, which could reduced complication and sequela of severe HFMD.