重症手足口病与呼吸道感染关系  

Relationship between severe hand-foot-mouth disease and respiratory tract infection

作　　者：任静朝[1,2] 段广才[1,2] 陈璐[1] 周广远[1] 丁世彬[1] 杨道坤[3] 申宝深 张光文[3] 李影 REN Jing-chao;DUAN Guang-cai;CHEN Lu(School of Public Health, Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang Medical University, Xinxiang, Henan Province 453003, Chin)

机构地区：[1]新乡医学院公共卫生学院河南省分子诊断与医学检验技术协同创新中心,河南新乡453003 [2]郑州大学公共卫生学院 [3]新乡医学院第一附属医院

出　　处：《中国公共卫生》2018年第6期894-897,共4页Chinese Journal of Public Health

基　　金：国家自然科学基金(81573205);河南省高等学校重点科研项目(15A330003);河南省博士后科研项目(2015013);河南省分子诊断与医学检验技术协同创新中心开放课题(XTCX-2015-PY3)

摘　　要：目的探讨重症手足口病与呼吸道感染的关系,以期为手足口病重症化发生机制和预防重症手足口病的发生提供思路。方法以某县城医院2015年5—11月收治的428例手足口病住院患儿为研究对象,通过查看病历收集对象一般人口学资料及病情等资料,根据《手足口病诊疗指南(2010年版)》将研究对象分为普通病例和重症病例2组,利用χ2检验和多因素logistic回归模型分析重症手足口病与呼吸道感染的关系。结果 428例研究对象中,重症病例200例(46.73%),普通病例228例(53.27%);并发呼吸道感染者328例(76.64%),其中并发扁桃体炎者262例(61.21%),并发下呼吸道感染者83例(19.39%)。重症手足口病与呼吸道感染存在统计学关联(χ2=15.636 1,P<0.000 1,OR=0.398,95%CI=0.251~0.633),与扁桃体炎存在统计学关联(χ2=12.010 1,P=0.000 5,OR=0.500,95%CI=0.337~0.742),尚未发现重症手足口病与下呼吸道感染存在关联(χ2=0.860 2,P=0.353 7)。在调整了发烧、最高体温、出疹、入院前用药情况等因素的影响后,重症手足口病与呼吸道感染、扁桃体炎的关联仍然存在(P<0.000 1)。结论重症手足口病与呼吸道感染存在关联,且该关联是由于重症手足口病与扁桃体炎的关联引起;并发扁桃体炎患儿比单纯普通手足口患儿发展成手足口重症的风险降低。Objective To investigate the relationship between severe hand-foot-mouth disease （HFMD） and respiratory tract infection, and to provide suggestions for the prevention of severe HFMD. Methods The study included 428 children with HFMD hospitalized in a county hospital from May to November 2015. Clinic and demographic information of the participants were extracted form their medical records. The participants were then assigned into a common and a severe HFMD group according to the ＂Guidelines for Diagnosis and Treatment of Hand-Foot-Mouth Disease （2013）＂. The relationship between severe HFMD and respiratory tract infection was analyzed with chi square test and multivariate logistic regression. Results Of the participants, 200 （46.73%） and 228 （53.27%） were severe and common cases; 328 （76.64%） were complicated with respiratory tract infection; 262 （61.21%） were complicated with tonsillitis and 83 （19.39%） with lower respiratory tract infection, respectively. Statistically significant correlation was observed between severe HFMD and respiratory tract infection （x^2 = 15.6361, P 〈 0.000 1; odds ratio [OR] = 0.398, 95% confidence interval [95% CI]： 0.251 - 0.633）. There was a significant correlation between severe HFMD and tonsillitis （x^2 = 12.010 1, P = 0.000 5, OR = 0.500, 95% CI： 0.337 - 0.742） but no significant correlation was found between severe HFMD and low respiratory tract infection （x^2 = 0.860 2, P = 0.353 7）. The associations of respiratory tract infection and tonsillitis with severe HFMD were of significance after adjusting for fever, maximum body temperature, rash, and medication before hospital admission （both P 〈 0.0001）. Conclusion Severe HFMD is associated with respiratory tract infection and the correlation is due to the association between severe HFMD and tonsillitis. The child HFMD cases complicated with tonsillitis are less likely to develop severe HFMD compared to common HFMD cases.

关 键 词：重症手足口病 呼吸道感染 扁桃体炎 

分 类 号：R183[医药卫生—流行病学]