Clinical study on blood routine and dynamic changes, condition and prognosis of hand foot and mouth disease (EV71)

HFMD outbreaks occur all the year round. The genotype of HFMD enterovirus that broke out in loudi city in 2010 was mainly EV71 [1]. Hand, foot and mouth disease (EV71) with increasing aggravation of blood picture [2], along with the ratio of neutrophils and lymphocytes change at the same time, through to our hospital on April 1, 2010 to May 31, 2010 critically ill, early intensive group and normal group (EV71) cases of hand, foot and mouth disease blood routine analysis and comparison, and cases of early intensive group dynamic blood picture observation, found that the routine blood leukocytes Abstract

Citation: Yao  cases in the acute phase of (early severe cases through routine blood review more than one), both through anal loudi CDC try sampling or sampling of EV71 diagnosed cases of hand, foot and mouth (sporadic cases confi rmed by sampling, gather and outbreak cases confi rmed by sampling

Research methods
Illness group and research steps: according to the guide on admission criteria whether the condition above cases can be divided into: (I group) group, the group (II) in acute severe early group, the group () group; All outpatient and hospitalized cases in the fi rst day of the hospital to check blood routine, for early cases severe group according to the requirements of the guide as soon as possible to give small doses of hormones (methylprednisolone 1-2 mg/kg) intervention, 12 to 24 h after the review of routine blood, root tree, foot and mouth disease in acute and recovery at different stages in the routine blood total number of white blood cells and neutrophils and lymphocytes ratio change to the above cases can be divided into three groups: group A, white blood cells and neutrophils ratio increased groups: higher total number of white blood cells, neutrophils ratio increased and reduced lymphocyte ratio; In group B, the leucocyte and lymphocyte ratio increased: the total number of white blood cells increased, neutrophil ratio decreased and lymphocyte ratio increased or the total number of white blood cells decreased, neutrophil ratio increased and lymphocyte ratio decreased. In group C, WBC decreased and lymphocyte ratio increased: total number of WBC decreased, neutrophil ratio decreased and lymphocyte ratio increased.

Statistical methods
The data were expressed as mean ± standard deviation (x±s). SPSS11.5 statistical software was used for statistical processing of the data. Analysis of variance was used for comparison among the measurement data groups, q test was used for pairwise comparison, and chi-square test was used for enumeration data.

Different condition
I, II group, III comparison between way: differences between groups of course no statistical signifi cance (P > 0.05), age, routine blood total number of White Blood Cells (WBC) and Neutrophils ratio (N) group differences were statistically signifi cant (P < 0.01). See Table 1. I group , II group , III group comparison between groups : duration of each group showed no signifi cant difference (P> 0.05), age, blood leukocyte count (WBC) and Neutrophil ratio (N) in each group differences were statistically signifi cant (P <0.01). Table 1.

Cases in the early severe group were further divided into group A, group B and group C for inter-group comparison
There was no statistical signifi cance in age and gender difference between each group (P>0.05). The differences in mortality were statistically signifi cant (X2=166.25, P<0.01).
The mortality of group A was signifi cantly higher than that of group B and group C. Are shown in Table 2.  to the ineffective treatment of antibiotics and the extremely limited effi cacy of antiviral drugs, the body mostly fi ghts off viral infection through its own antiviral immune function. The immune function of organism can be divided into specifi c immune function and non-specifi c immune function, and specifi c immune function can be further divided into cellular immune function and humoral immune function. According to the research of zeng huihui [2] and yan xiufeng [4], the more severe HFMD is, the lower the cellular immune function will be. Theoretically speaking, the organism compensates more through humoral immunity and non-specifi c immune functions, and achieves the relative balance and stability of anti-infection (virus) immune functions through the interaction and regulation of the above three. According to yan xiufeng et al., with the aggravation of the disease, the level of immunoglobulin gradually increases, which indicates that humoral immunity in children with severe HFMD is hyperactive [4]. Non-specifi c immune function is compensated by cytokines in humoral factors and neutrophils in phagocytes [5]. We believe that the clinical critical hand-foot-mouth disease in the late stage of the sustained high fever, and blood, c-reactive protein and other non-specifi c indicators signifi cantly increased, are related to the non-specifi c immune infl ammatory response compensatory enhancement. A large number of clinical data showed that most of the critically ill hand-foot-mouth disease (EV71) had signifi cantly increased blood picture, blood glucose, c-reactive protein and other indicators, and the clinical situation in our department was basically similar to the above report. In this paper, the changes of blood routine (blood picture) were discussed. As can be seen from Table 3: (1) with the increase of onset age, the body's autoimmune function is enhanced and the disease is relatively mild. The age of the critical group is mainly in the age range of 1-2 years, indicating the lowest autoimmune function in this age group, which is consistent with the experimental results of zeng huihui [3] et al. It may be related to the time when maternal antibodies gradually disappear and autoimmunity has not been established. (2) the heavier the disease, the higher the ratio of white blood cells and neutrophils, the heavier the systemic infl ammatory response. In the critical group, there was one case with the shortest history of 12 hours and the most severe systemic infl ammatory response. The ratios of WBC 35.2×109/L and N 95%, respectively. Most of the patients in this group had missed the opportunity of rescue and treatment when they came to the hospital. As can be seen from Table 1 of this group of cases, the heavier the disease, the higher the ratio of white blood cells and neutrophils, and the worse the prognosis. It is worth discussing whether its high mortality is related to organ failure caused by systemic infl ammatory response.
(3) the three groups of patients in the course of statistical comparison is not statistically signifi cant (P>0.05), but it can be seen from the Table: the serious group of patients in the course of longer than the other two groups, may be more serious illness, rash is not typical and with the grass-roots hospital medical staff diagnosis and treatment experience is insuffi cient.The increase of white blood cells in HFMD (EV71) was not completely consistent with the severity of the disease.
Further studies showed that the dynamic changes of white blood cells and various cell proportions in early severe cases were closely related to the trend of prognosis of the disease. Table 4 in