2008—2017年昆明地区住院手足口病患儿的临床特征研究  

Clinical Characteristics of Hospitalized Children with Hand-foot-mouth Disease in Kunming from 2008 to 2017

作　　者：王美芬[1] 符甜甜 罗云娇[1] 彭俊超 杜丽江 杜曾庆[1] 甘泉[1] 马薇 鲁智英 刘春莉 蒋鸿超[1] WANG Meifen;FU Tiantian;LUO Yunjiao;PENG Junchao;DU Lijiang;DU Zengqing;GAN Quan;MA Wei;LU Zhiying;LIU Chunli;JIANG Hongchao(Kunming Children's Hospital/Yunnan Key Laboratory of Children's Major Disease Research,Kunming 650034,China;Department of Pediatrics,Luoyang Central Hospital Affiliated to Zhengzhou University,Zhengzhou 471003,China)

机构地区：[1]云南省昆明市儿童医院,云南省儿童重大疾病研究重点实验室,650034 [2]郑州大学附属洛阳中心医院儿科,河南省郑州市471009

出　　处：《中国全科医学》2021年第11期1410-1417,共8页Chinese General Practice

基　　金：昆明市科技计划项目(2019-1-S-25318000001241,2017-1-S-15381);云南省教育厅科学研究基金项目(2018JS241);昆明市儿童感染性疾病病原检测技术及分子流行病学技术中心项目[SW(技)--02];云南省儿科临床疾病医学中心科技项目(YPMC-2019-07);云南省卫生高层次人才医学学科带头人项目(D2017-053);云南省中青年学术和技术带头人(D-2017053)。

摘　　要：背景手足口病是20多种肠道病毒感染引起的全球性传染病。自2008年以来,手足口病在我国发病率高,重症病例占比高,是危害我国儿童健康的急性传染病。目的探讨2008—2017年住院手足口病患儿的临床特征,提供云南省内大样本手足口病的临床数据。方法采用回顾性研究的方法通过电子病案系统收集2008—2017年在昆明市儿童医院住院的手足口病患儿的发病数、发病时间、年龄、性别、临床分型、分期等临床资料进行统计分析。结果(1)昆明地区10年间住院手足口病患儿共11510例,全年均有流行,呈单峰型,4—8月是发病高峰期。(2)住院患儿中男孩多于女孩,男女比例为1.13∶1,最小年龄为37 d,最大年龄为14岁6个月,平均年龄(2.37±1.50)岁;在不同年龄段均可发病,住院患儿中3岁及以下儿童发病率最高,共有9982例(86.72%);普通型病例3368例(29.26%),重症病例8142例(70.74%),重症病例中重型4690例(40.75%),危重型3452例(29.99%),3岁及以下儿童重症发生率为88.02%;不同年龄组手足口病在重型及危重型中的发生率差异有统计学意义(P<0.05)。(3)危重型手足口病早期均有高血压3452例(100%),心率快3273例(94.84%),呼吸增快2983例(86.44%),指趾端循环不良2408例(69.76%),肢体瘫痪63例(1.83%),尿潴留14例(0.41%)。(4)粪便病原学检查10234例(88.91%),其中肠道病毒71(EV71)有3843例(33.39%),柯萨奇病毒A组16型(COA16)有1112例(9.66%),其他肠道病毒有3560例(30.93%);2008—2013年病原主要以EV71和COA16感染为主,2014—2017年以其他类型肠道病毒和EV71感染为主,危重型手足口病的病原以EV71感染为主。结论住院手足口病患儿及重症人群主要是3岁及以下儿童,引起重症手足口病仍以EV71感染为主。高血压、心率快、呼吸增快、指趾端循环不良等是危重手足口病的早期信号,应积极给予救治和控制病情。Background Hand-foot-mouth disease(HFMD)is a global infectious disease caused by more than 20 kinds of enterovirus infections.Since 2008,HFMD has been a high-incidence acute infectious disease in China,with a high prevalence of severe cases,endangering children’s health.Objective To study the clinical characteristics and influencing factors of hospitalized pediatric HFMD cases using the data of a large clinical sample collected from Yunnan Province during 2008 to 2017.Methods A retrospective design was used.Data of HFMD children with hospitalization experience during 2008 to 2017 were collected through the electronic medical record system of Kunming Children’s Hospital,including number of cases,onset time,age,gender,clinical classification and staging of HFMD,and were analyzed using statistical methods.Results(1)A total of 11510 HFMD cases were hospitalized in this hospital during this 10-year period.The disease was prevalent throughout the year,and showed a single peak pattern,with a peak period from April to August.(2)Boys outnumbered girls,with a male to female ratio of 1.13:1.The children had an average age-of-onset of(2.37±1.50)years,but showed an uneven age-of-onset distribution,the youngest was 37 days,and the oldest was 14 years old,and those under 3 years had the highest incidence rate,accounting for the largest percentage of the total[86.72%(9982/11510)].There were 3368 common cases(29.26%),and 8142 severe cases(70.74%).Of the severe cases,intermediate-to-severe and critical cases accounted for 40.75%(4690/8142),and 29.99%(3452/8142),respectively,and the percentage of cases aged less than 3 years accounted for 88.02%.The incidence of severe and critical HFMD differed significantly across all age groups(P<0.05).(3)In the early stage of critical HFMD,the prevalence of hypertension,increased heart rate,accelerated respiration,poor blood circulation in tips of fingers and toes,limb paralysis,and urinary retention was 100.00%(3452/3452),94.84%(3273/3452),86.44%(2983/3452),69.76%(2408/3452),1.83%(63/3452

关 键 词：手足口病 住院患儿 临床特征 病原学 影响因素分析 

分 类 号：R725.1[医药卫生—儿科]