2000—2012年福建省急性弛缓性麻痹病例残留麻痹影响因素分析

Risk factors of residual paralysis among acute flaccid paralysis cases in Fujian,2000-2012

目的了解无脊髓灰质炎后残留麻痹(含死亡)的急性弛缓性麻痹(AFP)病例的流行病学特征及其影响因素。方法对2000—2012年福建省残留麻痹的AFP病例进行描述流行病学分析,对影响因素进行单因素和多因素非条件logistic回归分析。结果 2000—2012年1822例AFP病例中1790例(98.26%)在麻痹60天后进行了随访,发现残留麻痹病例295例(其中死亡17例),占16.48%。295例残留麻痹病例中,男童是女童的2.13倍,53.22%的病例<2岁;脊灰病毒阳性23例,非脊灰肠道病毒阳性24例。多因素分析显示<1岁发病、免疫史0次和1次、多次就诊、初始麻痹较严重、深部腱反射异常是AFP残留麻痹病例发生的危险因素。结论提高儿童脊髓灰质炎疫苗及时、全程接种率;加强对临床医生培训,及时发现AFP病例,对重症病例及时给予合理治疗,是减少AFP残留麻痹病例发生的相关措施。

Objective To understand the epidemiological characteristics and risk factors of paralysis sequela （including death） in acute flaccid paralysis （AFP） cases. Methods Descriptive epidemiological analysis was conducted on the related data of AFP cases with residual paralysis in Fujian from 2000 to 2012. The risk factors of paralysis sequela were analyzed with univariate and multivariate non-conditional logistic regression model. Results Totally 1790 of 1822 AFP cases （98.26%） were followed up 60 days after paralysis onset, and 295 cases （including 17 deaths） were found to be with residual paralysis. In 295 cases, the male cases was 2. 13 times more than female cases, and 53.22% of the cases were aged 〈 2 years. Polioviruses were isolated from 23 cases, and non polio enteroviruses were isolated from 24 cases. The results of multivariate non-conditional logistic regression analysis showed that the risk factors for residual paralysis included age 〈 1 year, unvaccinated or 1 dose vaccination history, visiting doctors many times, more serious initial paralysis and abnormal deep tendon reflex. Conclusion In order to reduce the incidence of residual paralysis in AFP case, effective measures must be taken, including improving timely and fully OPV immunization rate, strengthening clinical doctors training, timely detection of AFP cases and timely and rational treatment of severe cases.