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目的检测手足口病患儿血清中甲型肝炎病毒(HAV),分析合并HAV感染对患儿的影响。方法收集2009.6月-2013.10月确诊手足口病例577例。用酶联免疫吸附试验检测血清HAV抗-Ig M,比较甲肝合并肠道病毒71型(EV71)和科萨齐病毒A组16型(Cox A16)的感染率;分析比较合并甲肝感染组与非合并组患儿的临床表现;检测患儿血清中肝功能指标ALT、AST、ALP、GGT、PA、TBIL和DBIL水平,分析合并组与非合并组患儿肝功能损伤情况。结果 577例手足口病患儿中合并甲肝病毒感染32例,合并EV71感染率(6.9%)与合并Cox A16(3.2%)比较,差异无统计学意义(P>0.05);合并组患儿中精神差、抽搐、恶心、呕吐等神经系统症状较非合并患儿明显(P<0.05),而发热、乏力、纳差、腹痛、巩膜黄和尿色深在两组间比较,差异无统计学意义(P>0.05);合并组病程较非合并组长(P<0.05);合并组肝功能指标ALT、AST、GGT、ALP、TBIL、DBIL水平分别高于非合并组,而PA水平低于非合并组,各指标在两组间均有统计学意义(P<0.05)。结论手足口病患者中存在甲型肝炎病毒感染,合并甲型肝炎病毒感染对手足口病病情发展有促进作用。
Objective To detect the level of hepatitis A virus (HAV) in children with hand-foot-mouth disease and analyze the influence of HAV infection on children. Methods A total of 577 cases of hand, foot and mouth were collected from June 2009 to October 2013. Serum HAV anti-IgM was detected by enzyme-linked immunosorbent assay (ELISA), and the infection rates of EV71 and Cox A16 were compared. The clinical manifestations of children with acute pancreatitis were analyzed. The serum levels of ALT, AST, ALP, GGT, PA, TBIL and DBIL in serum were detected and the liver injury in children with and without the combination was analyzed. Results Among 577 HFMD patients, 32 cases were complicated with hepatitis A virus infection, and the infection rate of EV71 was 6.9% compared with that of Cox A16 (3.2%). There was no significant difference between the two groups (P> 0.05) Neurological symptoms such as poor spirits, convulsions, nausea and vomiting were significantly higher than those in non-children (P <0.05), but no difference was found between the two groups in fever, fatigue, anorexia, abdominal pain, sclera yellow and urine darkness (P> 0.05). The duration of the combined group was longer than that of the non-combined group (P <0.05). The levels of ALT, AST, GGT, ALP, TBIL and DBIL in the combined group were significantly higher than those in the non-combined group Non-combined group, the indicators in both groups were statistically significant (P <0.05). Conclusions Hepatitis A virus infection is present in HFMD patients. Hepatitis A virus infection may promote the development of HFMD.