济南市手足口病重症病例危险因素的病例对照研究

Risk factors of severe cases of hand, foot and mouth disease in Jinan City: a case-control study

目的探讨济南市手足口病重症病例发病的危险因素,为早期识别重症病例,降低手足口病重症病例的发生提供科学依据。方法采用病例对照研究方法,病例组为86例手足口病重症病例,对照组为86例手足口病轻症病例,用问卷调查收集病例组和对照组的社会人口学特征、接触史、就诊史、临床症状、实验室诊断等信息,对重症病例危险因素分析采用单因素和多因素非条件logistic回归分析。结果单因素结果显示发病到就诊日期、初诊单位类型为村级、患儿出现发热、足部皮疹、口腔疱疹、臀部皮疹、咳嗽、呕吐、有病例接触史、EV71阳性在两组间差异有统计学意义。多因素非条件Logistic回归分析结果显示,患儿出现发热(OR=89.38)、口腔疱疹(OR=22.28)、臀部皮疹(OR=234.81)、呕吐(OR=23.90)、有病例接触史(OR=31.48)和EV71阳性(OR=71.65)是手足口病重症病例发病的危险因素。结论早期识别发热、口腔疱疹、臀部皮疹、呕吐等症状的患儿,对降低手足口病重症病例的发生具有一定的参考意义。提高EV71手足口病疫苗的接种率,可降低由EV71导致的重症手足口病病例的发生率。

Objective To explore the risk factors of severe cases of hand, foot and mouth disease (HFMD) in Jinan city so as to provide a scientific basis for early identifying the severe cases and reducing the incidence of severe HFMD. Methods A case-controlled study was conducted in 86 severe HFMD cases (the severe HFMD group) and 86 mild HFMD cases (the control group). A questionnaire survey was performed to collect their socio-demographic characteristics, contact history, history of treatment, clinical symptoms, laboratory diagnosis and other information. Single factor and multi-factor unconditional logistic regression analyses were performed to identify the risk factors of the severe HFMD cases. Results Single-factor logistic regression analysis indicated that the factors, including the time from onset of illness to visiting, initial diagnosis of HFMD by village-level medicalunits, fever, foot skin rash, oral herpes, hip skin rash, cough, vomiting, having a history of case exposure and enterovirus 71 (EV71) infection, showed statistically significant differences between the two groups. Multi-factor unconditional logistic regression analysis revealed that fever (R=89.38), oral herpes (OR=22.28), hip skin rash (OR=234.81), vomiting (OR=23.90), having a history of case exposure (OR=31.48) and EV71 infection (OR=71.65) were the risk factors influencing the incidence of severe HFMD. Conclusions Early identifying the cases with symptoms like fever, oral herpes, hip skin rash and vomiting has some referenced effects on decreasing the incidence of severe HFMD. Improving the coverage rate of EV71 vaccine can reduce the incidence rate of severe HFMD caused by EV71 infection.