儿童手足口病重症病例影响因素的病例对照研究

Case-control study on effect factors of serve Hand-foot-mouth disease among children

目的:探讨儿童手足口病(hand-foot-mouth disease,HFMD)重症病例发生的影响因素。方法:采用性别、年龄、入院时间的1∶2匹配的方法对江苏省南京、镇江、扬州、常州市级医疗机构收治的手足口重症病例和轻症病例进行问卷调查,数据分析采用Cox比例风险模型进行单因素和多因素分析。手足口病原学的检测采用PCR方法进行确认。结果:单因素分析显示:发病-入院天数(OR=1.668,95%CI:1.307～2.128)、发热(OR=5.181,95%CI:1.939～13.844)、发热持续天数(OR=1.562,95%CI:1.1421～2.135)、颈项强直(OR=3.188,95%CI:1.055～9.634)、白细胞计数偏高(OR=1.038,95%CI:1.013～1.064)、中性粒细胞计数偏高(OR=1.235,95%CI:1.108～1.378)、Enterovirus 71(EV71)阳性感染(OR=5.069,95%CI:2.472～10.393)是儿童患手足口重症的危险因素,淋巴细胞计数增高(OR=0.968,95%CI:0.944～0.992)、Coxsackievirus A16(CoxA16)阳性(OR=0.191,95%CI:0.094～0.388)患手足口重症的风险比例较小;多因素分析结果显示:发病-入院天数、WBC计数偏高、中性粒细胞计数偏高是儿童患手足口重症的危险因素,其OR值分别为1.668(95%CI:1.122～2.477)、1.304(95%CI:1.080～1.575)、1.088(95%CI:1.001～1.184);CoxA16阳性的儿童患手足口重症的风险比例较小,其OR值为0.169(95%CI:0.038～0.753)。结论:加强对手足口患儿的临床监测和病原学监测,早期诊断,早期治疗,可以有效预防手足口患儿发展成重症的可能性。

Objective：To explore the effect factors of serve Hand-foot-mouth disease（HFMD）among children.Methods： A hospi-tal-based case-control study was conducted on two groups of children matched by sex,age and hospital of time.Interview was carried out with uniform designed questionnaires between the case-group with serious complication and control-group with mild symptoms.Cox’s proportional hazards regression analysis was then performed.The pathogen of HFMD was confirmed by RT-PCR.Results： Time intervals between onset date and admission date（OR=1.668,95%CI：1.307-2.128）,heating（OR=5.181,95%CI：1.939-13.844）、fever duration（OR=1.562,95%CI：1.142-2.135）,stiff neck（OR=3.188,95%CI：1.055-9.634）,the higher number of white blood cell（OR= 1.038,95% CI：1.013-1.064）and neutrophilic granulocyte（OR =1.235,95% CI：1.108-1.378）,and Enterovirus71 infection（OR = 5.069,95%CI：2.472-10.393）were risk factors of HFMD among children with serious symptoms,However,lymph-cell counts increase（OR=0.968,95%CI：0.944-0.992）,Children infected with CoxA16（OR=0.191,95%CI：0.094-0.388）were the protection factors.The risk factors were found with multivariate analysis,and were associated with time intervals between onset date and admission date（OR= 1.668,95%CI：1.122-2.477）,the higher number of white blood cell（OR=1.304,95%CI：1.080-1.575）and neutrophilic granulocyte（OR=1.088,95%CI：1.001-1.184）,The protections factors was associated with CoxA16 infection（OR=0.169,95%CI：0.038-0.753）.Conclusion： To strengthen clinical surveillance and etiology surveillance of HFMD disease,early diagnosis and early treatment can effectively prevent children developing severe hand-foot-and-mouth disease possibility.