非肠道病毒A组71型感染手足口病重症危险因素分析

Risk factors for non-enterovirus A71-associated severe hand,foot and mouth disease:a case-control study

目的分析非肠道病毒A组71型(enterovirus group Atype71,EV-A71)感染手足口病患者的重症危险因素,为尽早识别重症患者并及时治疗提供依据。方法收集深圳市宝安人民医院2015年5月～2016年11月收治的手足口病病例,明确感染的肠道病毒血清分型后选取非EV-A71感染的轻症和重症患者各185例,采用多因素条件Logistic回归方法筛选出重症手足口病的影响因素。结果经多因素条件Logistic回归分析,发现发热最高温≥39℃(OR=6.61,95%CI:3.17～13.81)、出疹类型为丘疹(OR=2.82,95%CI:1.40～5.69)、出疹部位为足部(OR=2.05,95%CI:1.08～3.90)、就诊延迟1 d内(OR=3.44,95%CI:1.56～7.58)、出生时有并发症(OR=7.37,95%CI:1.66～32.70)、非母乳喂养(OR=1.89,95%CI:1.01～3.54)、发病前常在小区玩耍(OR=2.92,95%CI:1.44～5.92)、经常咬玩具(OR=2.27,95%CI:1.13～4.53)为非EV-A71手足口病症的危险因素(均有P<0.05)。结论应密切关注患者临床、实验室和卫生习惯等多项指标,及时发现手足口病重症的危险因素并进行临床诊治和健康教育。

Objective To explore the risk factors for non-enterovirus A71 (EV-A71)-associated severe hand, foot and mouth disease （HFMD） for early identification and treatment of the disease. Methods HFMD patients from the Peo-ple＇ s Hospital of Baoan in Shenzhen City were enrolled from May, 2015 to November, 2016. Clinico-epidemiological data were recorded and patient samples were collected. The enterovirus serotype was identified using real-time PCR. Then the non-EV-A71 patients were divided into two groups, with 185 cases and 185 controls, respectively. Influential factors of severe cases were screened through multi-factor conditional likelihood ratio method. Results Fever temperature above 39 ℃ （OR =6. 61,95% CI：3.17-13.81), papule (OR = 2. 82,95% CI： 1.40-5.69）, rash on feet (OR = 2. 05, 95% CI： 1.08-3.90）, delay in seeing the doctor for one day (OR = 3.44,95% CI： 1.56-7.58), complications at birth (OR = 7. 37,95% CI： 1.66-32.70）, non-breast feeding (OR = 1.89, 95% CI： 1.01-3.54）, playing a lot in the neighborhood (OR = 2. 92,95 % CI： 1.44-5.92）, frequent toys chewing (OR = 2. 27,95 % CI： 1.13-4. 53) were the risk factors of severe cases （all P 〈 0.05). Conclusions Identifying risk factors of non-EV-A71-associated severe HFMD by clinical and laboratory methods will promote early diagnosis and treatment of the disease and provide evidence for health education.