2011-2012年杭州市儿童手足口病流行病学特征及重症病例危险因素分析  

Epidemiological analysis of hand-foot-mouth disease and risk factors of severe cases in Hangzhou in 2011-2012

作　　者：蔡春燕 王娟 王忠敏 赵仕勇 

机构地区：[1]杭州市儿童医院,浙江杭州310014

出　　处：《中国预防医学杂志》2016年第6期419-423,共5页Chinese Preventive Medicine

基　　金：浙江省医药卫生科技计划项目(2012KYB159)

摘　　要：目的了解2011-2012年杭州市儿童医院手足口病的流行病学特征、实验室检查特点,并分析重症手足口病的危险因素。方法采用描述性流行病学方法,对2011-2012年杭州市儿童医院就诊的手足口病患者资料进行统计分析,比较轻症和重症手足口病患者的流行病学特点、实验室检查指标差异,最后应用logistic回归分析筛选重症手足口病的危险因素。结果2011年1月~2012年12月,共报告手足口病2 706例,〈3岁者占70.29%（1 902例）,男性1 620例,女性1 086例,轻症2 138例,重症568例。2 656例（98.15%）患者有不同程度的发热,平均持续2~3d。与轻症患者比较,重症患者更易出现高热（P〈0.05）,胸片异常率更高（P〈0.05）,外周血白细胞计数、中性粒细胞百分比、血小板计数、C反应蛋白、血糖、免疫球蛋白及补体C3水平也显著升高（P〈0.05）。细胞因子显示,重症患者急性期外周血IFN-γ、IL-10、IL-6水平较轻症患者显著升高（P〈0.05）。病原学检查显示,重症组肠道病毒71型（EV71）感染阳性率更高（P〈0.05）。多因素logistic回归分析显示,年龄〈3岁、居住在农村、高热（〉39℃）、延迟就诊、白细胞升高、免疫球蛋白IgM升高、EV71感染、IL-6水平升高这9个变量为重症手足口病的危险因素。结论杭州市手足口病的发生存在明显的年龄、性别、地区差异,CA16和EV71感染同时存在,但重症患者以EV71感染为主。年龄〈3岁、居住在农村、高热（〉39℃）、延迟就诊、白细胞升高、免疫球蛋白IgM升高、EV71感染、IL-6水平升高这9个变量为重症手足口病的危险因素,早期识别这些危险因素有助于疾病治疗。Objective To understand the epidemiological features of hand-foot-mouth disease（HFMD）in Hangzhou Children′s Hospital from 2011 to 2012,and to analyze the risk factors of severe HFMD cases. Methods A descriptive epidemiological method was used to analyze data of patients with HFMD in Hangzhou Children′s Hospital during 2011 to 2012.Epidemiological characteristics and laboratory examination indexes were compared between mild and severe cases. Results A total of 2 706 cases of HFMD were reported during2011 to 2012with 2 138 mild cases and 568 severe cases.Majority of patients（70.29%）were under 3years old.Male cases were more than female ones.98.15% of patients had fever for 2to 3days,especially those with severe HFMD,who were more likely to have abnormal chest X-ray and with more WBC counts,higher percentage of neutrophilic granulocyte and increased number of platelet and elevated CRP,blood glucose,IgG,IgM and C3 levels compared to patients with mild HFMD（P〈0.05）.There was a significant difference of IFN-γ,IL-10,IL-6levels and EV71 prevalence between patients with mild and severe HFMD（P〈0.05）.The logistic analysis revealed that risk factors for severe cases were age,residence,fever,delayed visit,EV71 infection,as well as high levels of WBC,IgM,and IL-6. Conclusions The incidence of HFMD in Hangzhou has obvious age,gender,and regional characteristics.CA16 and EV71are the main pathogens,but EV71 infection is more prevalent in severe cases.More attention should be paid to the risk factors for severe cases,which may help prevent and control severe hand-foot-mouth diseases.

关 键 词：手足口病 流行病学特征 重症 LOGISTIC回归分析 

分 类 号：R725.1[医药卫生—儿科] R181.3[医药卫生—临床医学]