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新生儿肠道病毒感染的临床特征分析
Clinical features of neonatal enterovirus infection
目的 分析新生儿肠道病毒感染特别是重症肠道病毒感染的临床特征。方法 回顾性选择244例肠道病毒感染新生儿为研究对象。根据感染严重程度，分为普通感染组（n=231）和重症感染组（n=13），比较两组患儿的临床特征。结果 244例患儿中，207例（84.8%）在5~10月份发病，其中6~7月份发病人数最多。与普通感染组相比，重症感染组患儿出生胎龄小，早产儿比例高（P < 0.05）。重症感染组患儿发病时间早于普通感染组（P < 0.05）；皮疹、呼吸道症状、少吃少哭少动等败血症表现的发生率，伴发肺炎、心肌炎、坏死性肝炎和弥散性血管内凝血的发生率，以及血小板减少、凝血酶原时间延长、肌酸激酶同工酶升高和丙氨酸氨基转移酶升高的发生率，均高于普通感染组（P < 0.05）。重症感染组患儿病死率高于普通感染组（P < 0.05）。结论 新生儿肠道病毒普通感染和重症感染病例在起病时间、常见临床表现以及伴发疾病等方面均有显著不同。在肠道病毒流行季节，若新生儿出现皮疹和/或少吃少哭少动等败血症表现，特别是实验室检查提示肝功能损害以及凝血功能障碍，需高度警惕重症肠道病毒感染的可能。
Objective To study the clinical features of neonatal enterovirus infection, especially severe enterovirus infection. Methods A retrospective analysis was performed for the clinical data of 244 neonates with enterovirus infection. According to the severity of infection, they were divided into a common infection group with 231 neonates and a severe infection group with 13 neonates. Clinical features were compared between the two groups. Results Of the 244 neonates, 207 (84.8%) developed the disease in May to October, with the highest number of patients in June to July. Compared with the common infection group, the severe infection group had a significantly lower gestational age at birth and a significantly higher proportion of preterm infants (P < 0.05). Compared with the common infection group, the severe infection group had a significantly earlier onset time (P < 0.05) and significantly higher incidence rates of skin petechiae and ecchymosis, respiratory symptoms, sepsis-like manifestations (poor appetite, crying less, and less movement), concomitant diseases (such as pneumonia, myocarditis, necrotic hepatitis, and coagulation disorder), thrombocytopenia, prolonged prothrombin time, elevated creatine kinase-MB, and elevated alanine aminotransferase (P < 0.05). The severe infection group had a significantly higher mortality rate than the common infection group (P < 0.05). Conclusions There are significant differences in onset time, common clinical manifestations, and concomitant diseases between the neonates with common and severe enterovirus infection. In the enterovirus epidemic season, if the neonates have rashes and/or sepsis-like manifestations such as poor appetite and less movement, especially if the laboratory tests suggest liver damage and coagulation dysfunction, it is necessary to pay particular attention to the possibility of severe enterovirus infection.
Enterovirus infection / Clinical feature / Hepatic necrosis / Neonate
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