济南市2012—2013年手足口病重症患者流行病学及影响因素分析

Influence factors of severe hand-foot-mouth disease incidents in Ji'nan city,2012-2013

目的对2012—2013年济南市手足口病重症患者进行流行病学调查并对其影响因素进行分析。方法选取2012—2013年济南市部分手足口病重症患者进行问卷调查,并对相关资料及致病危险因素采用非条件logistic回归分析方法进行分析。结果 2012—2013年济南市<5岁儿童手足口病重症发病率为95.38%,且随着年龄的增加重症发病率呈下降趋势(χ2=195.43,P<0.01);手足口病重症发病主要以散居儿童(81.15%)和幼托儿童(16.92%)为主,学生为1.92%,散居儿童手足口病重症发病率明显高于其他人群(χ2=123.24,P<0.01);手足口重症患者致病毒株主要为EV71型84例,阳性率为70.0%;采用多因素logistic回归模型分析显示,患者年龄、就医时间延迟、发热、口腔溃疡、皮疹及EV71阳性(OR=4.35、1.43、2.54、1.96、3.78、19.65,P<0.05)是重症发病的危险因素。结论济南市手足口病重症发病率较高,且以EV71型毒株感染为主,对较小年龄的患者应加强预防,及时就诊,减少重症病例的发生。

Objective To explore epidemiologic characteristics and influencing factors of severe hand-foot-mouth dis- ease（HFMD） incidents in Ji＇nan city from 2012 through 2013. Methods All severe HFMD cases diagnosed during the two years in Ji＇nan city were surveyed with a questionnaire and the data collected were analyzed with unconditional logis- tic regression. Results Almost all HFMD incidents under the age of 5 years were severe HFMD（496/520,95.38% ） and the proportion of severe HFMD cases decreased with the increment of age among the HFMD cases （ linear tendency： X2 = 195.43 ,P 〈0. 01 ） during the period. Of the severe HFMD cases,81.15% were scattered children, followed by pre- school children（16. 92% ） and students（ 1.92% ）. The incidence of severe HFMD was significantly higher among the scattered children than among the residents of other age groups （X2 = 123.24, P 〈 0.01 ）. The positive rate were 70. 0% for enterovirus-71 （EV71） among 120 severe HFMD cases with pathogenic detections of stool, throat swab, cerebrospinal fluid specimens. Multivariate logistic regression analysis showed that the risk factors of severe HFMD incident included age, delay in seeking medical treatment, fever, oral ulcer, skin rash, and positive to EV71, with the odds ratios of 4. 35, 1.43,2. 54,1.96,3.78, and 19. 65, respectively, （ all P 〈 0. 05 ）. Conclusion The incidence rate of severe HFMD in Ji＇nan city is high;EV71 is the main pathogen related to the severe HFMD incidents and small children is the key popula- tion for the control of severe HFMD incidents.