儋州市2014-2016年手足口病重症病例的危险因素分析
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摘要
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.
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.
引文
[1]Zeng G,Luo KW,Hu SX,et al.Epidemiological analysis of severe cases of hand foot mouth disease in Hunan Province in year 2009-2015[J].Zhongguo Redai Yixue,2017,17(2):143-146.(in Chinese)曾舸,罗垲炜,胡世雄,等.湖南省2009-2015年手足口病重症病例流行病学分析[J].中国热带医学,2017,17(2):143-146.
[2]Zhang W,Huang B,She C,et al.An epidemic analysis of hand,foot,and mouth disease in Zunyi,China between 2012and 2014[J].Saudi Med J,2015,36(5):593-598.
[3]Shi P,Qian YH,Zhu JY,et al.Epidemiological and etiological characteristics of hand foot mouth disease in Wuxi during 2009-2014[J].Zhonghua Jibing Kongzhi Zazhi,2016,20(10):1014-1017.(in Chinese)石平,钱燕华,朱晶颖,等.2009-2014年无锡市手足口病聚集性疫情流行病学及病原学特征分析[J].中华疾病控制杂志,2016,20(10):1014-1017.
[4]Xia Y,Shan J,Ji H,et al.Study of the epidemiology and etiological characteristics of hand,foot,and mouth disease in Suzhou City,East China,2011-2014[J].Arch Virol,2016,161(7):1933-1943.
[5]Ministry of Health of the PRC.Guidelines for the diagnosis and treatment of hand foot mouth disease(2010 Edition)[J].Guoji Huxi Zazhi,2010,30(24):1473-1475.(in Chinese)中华人民共和国卫生部.手足口病诊疗指南(2010年版)[J].国际呼吸杂志,2010,30(24):1473-1475.
[6]Huang YD,Deng H,Ayguli Doylehadley,et al.Epidemiological analysis of hand foot mouth disease in Xinjiang in 2015[J].Zhonghua Jibing Kongzhi Zazhi,2017,21(3):321-322.(in Chinese)黄永迪,邓红,阿依古丽·伊尔哈力,等.2015年新疆手足口病流行病学分析[J].中华疾病控制杂志,2017,21(3):321-322.
[7]Lai FF,Yan Q,Ge SX,et al.Epidemiologic and etiologic characteristics of hand,foot,and mouth disease in Chongqing,China between 2010 and 2013[J].J Med Virol,2016,88(3):408-416.
[8]Fu T,Yang JJ,Lin WK,et al.Risk factors of severe cases of hand foot mouth disease in Southern Hainan Province[J].Jiefangjun Yixueyuan Xuebao,2017,38(2):132-135.(in Chinese)符婷,杨进军,林文科,等.海南省南部地区手足口病重症病例危险因素分析[J].解放军医学院学报,2017,38(2):132-135.
[9]Pan H,Zheng YX,Mao SH,et al.Study on risk factors of severe cases of hand foot mouth disease in Shanghai[J].Zhonghua Liuxingbingxue Zazhi,2012,33(8):763-767.(in Chinese)潘浩,郑雅旭,毛盛华,等.上海市手足口病重症病例危险因素研究[J].中华流行病学杂志,2012,33(8):763-767.
[10]Li XT,Li JN,Jia L,et al.Study on influencing factors of severe cases of hand foot mouth disease in Beijing[J].Guoji Bingduxue Zazhi,2014,21(5):198-202.(in Chinese)李锡太,李婧楠,贾蕾,等.北京市手足口病重症病例影响因素研究[J].国际病毒学杂志,2014,21(5):198-202.
[11]Cai CY,Wang J,Wang ZM,et al.Epidemiological characteristics of hand foot mouth disease and risk factors of severe cases in Hangzhou city in 2011-2012[J].Zhongguo Yufang Yixue Zazhi,2016,17(6):419-423.(in Chinese)蔡春燕,王娟,王忠敏,等.2011-2012年杭州市儿童手足口病流行病学特征及重症病例危险因素分析[J].中国预防医学杂志,2016,17(6):419-423.
[12]Fan X,Jiang J,Liu Y,et al.Detection of human enterovirus71 and coxsackievirus A16 in an outbreak of hand,foot,and mouth disease in Henan Province,China in 2009[J].Virus Genes,2013,46(1):1-9.
[13]De W,Changwen K,Wei L,et al.A large outbreak of hand,foot,and mouth disease caused by EV71 and CAV16 in Guangdong,China,2009[J].Arch Virol,2011,156(6):945-953.
[2]Zhang W,Huang B,She C,et al.An epidemic analysis of hand,foot,and mouth disease in Zunyi,China between 2012and 2014[J].Saudi Med J,2015,36(5):593-598.
[3]Shi P,Qian YH,Zhu JY,et al.Epidemiological and etiological characteristics of hand foot mouth disease in Wuxi during 2009-2014[J].Zhonghua Jibing Kongzhi Zazhi,2016,20(10):1014-1017.(in Chinese)石平,钱燕华,朱晶颖,等.2009-2014年无锡市手足口病聚集性疫情流行病学及病原学特征分析[J].中华疾病控制杂志,2016,20(10):1014-1017.
[4]Xia Y,Shan J,Ji H,et al.Study of the epidemiology and etiological characteristics of hand,foot,and mouth disease in Suzhou City,East China,2011-2014[J].Arch Virol,2016,161(7):1933-1943.
[5]Ministry of Health of the PRC.Guidelines for the diagnosis and treatment of hand foot mouth disease(2010 Edition)[J].Guoji Huxi Zazhi,2010,30(24):1473-1475.(in Chinese)中华人民共和国卫生部.手足口病诊疗指南(2010年版)[J].国际呼吸杂志,2010,30(24):1473-1475.
[6]Huang YD,Deng H,Ayguli Doylehadley,et al.Epidemiological analysis of hand foot mouth disease in Xinjiang in 2015[J].Zhonghua Jibing Kongzhi Zazhi,2017,21(3):321-322.(in Chinese)黄永迪,邓红,阿依古丽·伊尔哈力,等.2015年新疆手足口病流行病学分析[J].中华疾病控制杂志,2017,21(3):321-322.
[7]Lai FF,Yan Q,Ge SX,et al.Epidemiologic and etiologic characteristics of hand,foot,and mouth disease in Chongqing,China between 2010 and 2013[J].J Med Virol,2016,88(3):408-416.
[8]Fu T,Yang JJ,Lin WK,et al.Risk factors of severe cases of hand foot mouth disease in Southern Hainan Province[J].Jiefangjun Yixueyuan Xuebao,2017,38(2):132-135.(in Chinese)符婷,杨进军,林文科,等.海南省南部地区手足口病重症病例危险因素分析[J].解放军医学院学报,2017,38(2):132-135.
[9]Pan H,Zheng YX,Mao SH,et al.Study on risk factors of severe cases of hand foot mouth disease in Shanghai[J].Zhonghua Liuxingbingxue Zazhi,2012,33(8):763-767.(in Chinese)潘浩,郑雅旭,毛盛华,等.上海市手足口病重症病例危险因素研究[J].中华流行病学杂志,2012,33(8):763-767.
[10]Li XT,Li JN,Jia L,et al.Study on influencing factors of severe cases of hand foot mouth disease in Beijing[J].Guoji Bingduxue Zazhi,2014,21(5):198-202.(in Chinese)李锡太,李婧楠,贾蕾,等.北京市手足口病重症病例影响因素研究[J].国际病毒学杂志,2014,21(5):198-202.
[11]Cai CY,Wang J,Wang ZM,et al.Epidemiological characteristics of hand foot mouth disease and risk factors of severe cases in Hangzhou city in 2011-2012[J].Zhongguo Yufang Yixue Zazhi,2016,17(6):419-423.(in Chinese)蔡春燕,王娟,王忠敏,等.2011-2012年杭州市儿童手足口病流行病学特征及重症病例危险因素分析[J].中国预防医学杂志,2016,17(6):419-423.
[12]Fan X,Jiang J,Liu Y,et al.Detection of human enterovirus71 and coxsackievirus A16 in an outbreak of hand,foot,and mouth disease in Henan Province,China in 2009[J].Virus Genes,2013,46(1):1-9.
[13]De W,Changwen K,Wei L,et al.A large outbreak of hand,foot,and mouth disease caused by EV71 and CAV16 in Guangdong,China,2009[J].Arch Virol,2011,156(6):945-953.