儋州市2014-2016年手足口病重症病例的危险因素分析

Risk factors of severe hand,foot and mouth diseases in Danzhou of China

目的探讨儋州市手足口病(hand,foot and mouth disease,HFMD)重症病例的相关危险因素,为防控工作提供依据。方法收集儋州市2014年1月至2016年12月住院的手足口病重症患儿582例作为病例组,随机抽取同期手足口病普通患儿582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,应用单因素及多因素logistic回归法分析手足口病重症病例的相关危险因素,并采用受试者工作特征(ROC)曲线评价logistic回归模型的预测效果。结果单因素分析结果显示,年龄<3岁、散居儿童、家庭儿童数≥3、家庭人均居住面积≤15 m2、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≥3、外周血白细胞计数升高、EVA71病毒感染与HFMD重症病例发生相关(P<0.05)。多因素logistic回归分析结果显示,散居儿童、初诊未诊断手足口病、发病前接触患病儿童、半年内就医次数≥3、外周血白细胞计数升高、EV-A71病毒感染是HFMD重症病例发生的独立危险因素,其OR值及95%CI分别为1.674(1.586~1.904)、5.716(4.478~8.095)、1.316(1.205~1.573)、1.186(1.104~1.286)、3.365(2.916~6.587)、2.147(1.763~3.018)。ROC曲线评价logistic回归模型预测效果的曲线下面积(AUC)及95%CI为0.886(0.823~0.964)。结论手足口病重症病例的危险因素较多,应尽早采取有效措施,加强对疾病的监测,以降低手足口病的病死率。

Objective To analyze risk factors of severe cases of hand,foot amd mouth disease（HFMD） in Danzhou of China. Methods A case control study was conducted with 582 reported children suffered severe hand,foot and mouth disease in Danzhou city of China from January 2014 to December 2016. At the same time,a group of 582 nonsevere cases were randomly selected as controls. Univariate and multivariate logistic regression was done for the risk factor analysis. Receiver operating curve（ROC） was drawn to evaluate the prediction results of the logistic regression model. Results Single factor analysis showed that children age 3 years old,scattered children,number of children in one family ≥3,per capita living space ≤15 m2,misdiagnosis at the first visit,time interval between onset and initial visit ≤1 day,contact with sick children,dirty hands of the sick children,dirty hands of the adults caring the children,six months of medical treatment ≥3 times,increased peripheral white blood cell count,EV-A71 virus infection are significantly associated with severe HFMD cases（P 0. 05）. Multivariate logistic regression analysis showed that scattered children,misdiagnosis at first visit,contact with sick children,six months of medical treatment≥3 times,increased peripheral white blood cell count and EV-A71 virus infection were independent risk factors for severe HFMD cases1. 286）,3. 365（2. 916-6. 587）,2. 147（1. 763-3. 018）. ROC evaluated the logistic regression model to predict the effect under the curve of area（AUC） and 95% CI was 0. 886（0. 823-0. 964）. Conclusions There are many risk factors for severe cases of hand,foot and mouth disease and effective measures should be taken as early as possible to strengthen the monitoring of this disease.