海南省南部地区手足口病重症病例危险因素分析

Risk factors of severe hand-foot-mouth disease in the southern area of Hainan Province

目的探讨海南省南部地区手足口病(hand-foot-mouth disease,HFMD)重症病例的相关危险因素,为防控工作提供依据。方法采用病例对照研究方法,收集海南省南部地区2012年1月-2015年12月住院的手足口病重症患儿663例作为病例组,随机抽取同期手足口病普通患儿624例作为对照组。采用问卷调查方式记录病例组和对照组的基线资料,应用单因素和多因素非条件Logistic回归分析手足口病重症病例发生的相关危险因素。结果单因素分析显示,患儿年龄<3岁、散居儿童、居住农村、家庭人口数≥6、家庭儿童数≥3、家庭人均居住面积≤15 m^2、初诊未诊断手足口病、发病至首次就诊时间间隔≤1 d、发病前1个月接种疫苗、发病前接触患病儿童、患儿手部不清洁、看护人手部不清洁、半年内就医次数≥2次、外周血白细胞计数升高、EV71病毒感染与重症手足口病发生相关(P<0.05)。多因素Logistic回归分析显示,散居儿童、家庭儿童数、初诊未诊断手足口病、发病前接触患病儿童、患儿手部不清洁、半年内就医次数、EV71病毒感染是重症手足口病发生的独立危险因素,其OR(95%CI)分别为1.653(1.564~1.875)、2.085(1.957~2.316)、5.842(5.623~8.274)、1.816(1.735~2.024)、3.387(3.266~6.741)、2.247(2.105~2.618)、2.518(2.341~2.826)。结论重症手足口病发生的危险因素较多,需采取相应措施,加强对疾病的监测,防范重症手足口病的发生。

Objective To investigate the risk factors of severe cases of hand-foot-mouth disease（HFMD） in southern Hainan, and to provide evidence for prevention and control.Methods Case control study was used with 663 cases of children with severe hand-footmouth disease in southern region of Hainan province from January 2012 to December 2015 as a case group, and 624 cases with mild disease in the same period as the control group.The baseline data of case group and control group were recorded by questionnaires, and the risk factors of severe cases of hand-foot-mouth disease were analyzed by univariate and multivariate non conditional logistic regression analysis.Results Univariate analysis showed that children age3 years old, scattered children, living in rural areas, family population≥6, number of children in the family≥3, per capita living space≤15 m2, missed diagnosis at first clinic visit, time interval between onset and initial visit≤1 day, vaccination one month before the onset, contact with sick children, poor hand hygiene in children, poor hand hygiene in nursing staff, clinic visit≥2 times in 6 months, increased peripheral blood white blood cell count, and EV71 virus infection were associated with severe cases of hand-foot-mouth disease（P〈0.05）.Multivariate logistic regression analysis showed that scattered children, number of children in the family, missed diagnosis at first clinic visit, contact with sick children, poor hand hygiene in children, clinic visit≥2 times in 6 months, EV71 virus infection were independent risk factors for severe cases with hand-foot-mouth disease.The OR and 95% CI were 1.653（1.564-1.875）, 2.085（1.957-2.316）, 5.842（5.623-8.274）, 1.816（1.735-2.024）, 3.387（3.266-6.741）, 2.247（2.105-2.618）, 2.518（2.341-2.826）, respectively.Conclusion Major risk factors of hand-foot-mouth disease are shown in these severe cases, and the corresponding measures should be taken to strengthen the monitoring of the disease, and prevent the occurrence of severe cases of hand-foot-mouth disease.