华南地区手足口病的临床特征、病原谱和肠道病毒71型的生物学特点调研

Clinical characteristics,pathogen spectrum of hand foot mouth disease and the biological characteristics of hand foot mouth disease caused by enterovirus 71 in Southern China area

目的调研华南地区手足口病患儿的临床特征、病原谱及肠道病毒71型(EV71)所致的手足口病的生物学特点。方法选取2017年1~12月华南地区手足口病监测哨点的350例患儿为研究对象(病例组,n=350),并选取同期入院体检的30例健康儿童为正常对照(对照组,n=30)。采用自制调查问卷调查手足口病患儿临床特征,采用Logistic多元回归分析影响手足口病发生相关的主要因素;检测手足口病病原谱,比较不同季节各型手足口病患儿所占比例。比较EV71所致手足口病与非EV71所致手足口病患儿的临床特征及实验室指标的差异。结果Logistic多元回归分析结果显示,玩具未定期消毒、未饲养宠物、接触过类似症状者、接触过公共设施、卫生习惯差、家长不了解是华南地区手足口病发病的独立影响因素(P<0.05)。病原类型为EV71、柯萨奇病毒A16(CA16)、柯萨奇病毒A6(CA6)患儿所占比例分别为28.29%、21.14%、19.14%。华南地区夏季、秋季手足口病发病率明显高于冬季、春季(P<0.05)。EV71组患儿发热热程较非EV71组明显延长、体温较非EV71组明显升高(P<0.05)。结论 夏季、秋季是手足口病的高发期,玩具未定期消毒、未饲养宠物、有接触史、卫生习惯差、家长对手足口病不了解是华南地区手足口病发病的独立影响因素;手足口病病原类型占比前三位依次为EV71、CA16、CA6,EV71所致手足口病患儿发热热程较长、体温较高。

Objective To investigate the clinical characteristics,pathogen spectrum of hand foot mouth disease(HFMD) and the biological characteristics of HFMD caused by enterovirus 71 in Southern China area.Methods A total of 350 children with HFMD in disease surveillance sentinel hospitals in Southern China from January 2017 to December-2017 were enrolled as research subjects(case group,n=350),and 30 healthy children were enrolled as control group(n=30).A self-made questionnaire was used to investigate the clinical characteristics of children with HFMD,and Logistic multivariate regression analysis was used to analyze the main factors related to HFMD.The pathogen spectrum of HFMD was detected,and the proportion of children with HFMD in different seasons was compared.Moreover the clinical characteristics and laboratory indexes of children with HFMD caused by EV71 and HFMD caused by non EV71 were observed and compared.Results Logistic multivariate regression analysis showed that the independent influencing factors of HFMD in Southern China were the toys without regularly sterilizing,raising pets,having similar symptoms,exposure to public facilities,poor health habits and parents’ lack of understanding the disease.The proportions of children patients with EV71,CA16 and CA6 were 28.29%,21.14% and 19.14%,respectively.The incidence rate of HFMD in summer and autumn was significantly higher than that in winter and spring(P<0.05).The fever duration in group EV71 was significantly longer than that in non EV71 group, and patient’s body temperature was significantly higher than that in non EV71 group(P<0.05).Conclusion Summer and autumn are the high onset period of HFMD.The toys without regular disinfection,keeping pets,contact history,poor hygiene habits and parents’ lack of understanding HFMD are the independent influencing factors of HFMD in Southern China area.The types of pathogens of HFMD are EV71,CA16,CA6 in order,moreover,the HFMD caused by EV71 has the characteristics of longer fever duration and the higher body temperature.