诸暨市儿童手足口病流行状况及重症发生的危险因素分析
摘要
目的探讨诸暨市儿童手足口病的流行状况及重症手足口病发生的危险因素,为制定城区儿童防治该病的措施提供可靠的依据。方法归纳分析2012年12月-2015年12月诸暨市第二人民医院收治且临床资料较为完整的248例手足口病患儿的流行病学特征、症状和体征、病原学检查结果等临床资料,在进行单因素分析并采用Logistic回归方法进行危险因素分析。结果本组248例患儿普通病例190例,重症病例58例。单因素分析显示,年龄(<3岁)、高热、有呼吸困难发绀、抽搐发作、嗜睡或神萎、眼球运动异常、血压升高、血清肌酸激酶同工酶(CK-MB)(>24 U/L)、肠道病毒71(EV71)核酸检测阳性、肺炎胸片与重症手足口病的发生密切相关。多因素Logistic回归模型中发现影响重症手足口病发生的独立危险因素有年龄(<3岁)(P=0.011,OR=3.146)、抽搐发作(P=0.016,OR=5.246)、眼球运动异常(P=0.002,OR=6.357)、血清CK-MB(>24 U/L)(P=0.012,OR=3.464)、EV71核酸检测阳性(P=0.006,OR=2.198)、肺炎胸片(P=0.003,OR=4.816)。结论重症手足口病发生的独立危险因素有年龄(<3岁)、抽搐发作、眼球运动异常、血清CK-MB(>24 U/L)、EV71核酸检测阳性、肺炎胸片。
引文
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[14]聂轶飞,潘静静,王彦霞,等.2011年河南省手足口病流行病学特征分析[J].当代医学,2013,20(11):160-162.
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[16]Song C,Yibing C,Guo Y,et al.Risk factors of severe hand,foot and mouth disease complicated with cardiopulmonary collapse[J].Infect Dis(Lond),2015,47(7):453-457.
[17]Chen SM,Du JW,Jin YM,et al.Risk factors for severe handfoot-mouth disease in children in Hainan,China,2011-2012[J].Asia Pac J Public Health,2015,27(7):715-722.
[2]董秀玲,郑倩,董秀莲.重症手足口病患儿162例临床护理[J].齐鲁护理杂志,2010,16(3):28.
[3]中华人民共和国卫生部.手足口病诊疗指南(2008年版)[J].医药导报,2009,28(3):404-405.
[4]Owatanapanich S,Wutthanarungsan R,Jaksupa W,et al.Risk factors for severe hand,foot and mouth disease[J].Southeast Asian J Trop Med Public Health,2015,46(3):449-459.
[5]王仁媛,李秋兰,陈姣.小儿重症手足口病感染特点[J].中华医院感染学杂志,2014,24(3):247-249.
[6]Xu W,Jiang L,Thammawijaya P,et al.Hand,foot and mouth disease in Yunnan Province,China,2008-2010[J].Asia Pac J Public Health,2015,27(2):769-777.
[7]马波,陈瑞刚,窦社伟,等.儿童手足口病的胸部影像表现[J].中华放射学杂志,2010,44(9):943-945.
[8]葛善飞,郭堑,徐阳曦,等.手足口病重症病例的多因素分析[J].广西医科大学学报,2012,29(2):295-297.
[9]Chew SP,Chong SL,Barbier S,et al.Risk factors for severe hand foot mouth disease in Singapore:a case control study[J].BMC Infect Dis,2015,15(1):486.
[10]徐武秀,郭君怡,徐武敏.手足口病患儿复发感染的危险因素分析[J].中华医院感染学杂志,2015,25(9):2126-2127.
[11]王福春.广西靖西县2008-2012年手足口病流行特征分析[J].中国预防医学杂志,2014,9(1):62-66.
[12]Li Y,Dang S,Deng H,et al.Breastfeeding,previous EpsteinBarr virus infection,Enterovirus 71 infection,and rural residence are associated with the severity of hand,foot,and mouth disease[J].Eur J Pediatr,2013,172(5):661-666.
[13]Teng S,Wei Y,Zhao SY,et al.Intestinal detoxification time of handfoot-and-mouth disease in children with EV71 infection and the related factors[J].World J Pediatr,2015,11(4):380-385.
[14]聂轶飞,潘静静,王彦霞,等.2011年河南省手足口病流行病学特征分析[J].当代医学,2013,20(11):160-162.
[15]党双锁,邓慧玲,李亚萍,等.1381例手足口病患者的流行病学及临床特征分析[J].中华实验和临床感染病杂志(电子版),2013,7(4):20-23.
[16]Song C,Yibing C,Guo Y,et al.Risk factors of severe hand,foot and mouth disease complicated with cardiopulmonary collapse[J].Infect Dis(Lond),2015,47(7):453-457.
[17]Chen SM,Du JW,Jin YM,et al.Risk factors for severe handfoot-mouth disease in children in Hainan,China,2011-2012[J].Asia Pac J Public Health,2015,27(7):715-722.