| 张静,靳妍,孙军玲,王彦霞,王显军,伏晓庆,缪梓萍,吕强.手足口病重症病例临床分期与结局分析[J].中华流行病学杂志,2017,38(5):651-655 |
| 手足口病重症病例临床分期与结局分析 |
| Clinical stages and outcomes of severe cases on hand，foot and mouth disease |
| 收稿日期:2016-12-23 出版日期:2017-05-18 |
| DOI：10.3760/cma.j.issn.0254-6450.2017.05.019 |
| 中文关键词: 手足口病 重症病例 临床分期 临床结局 |
| 英文关键词: Hand, foot and mouth disease Severe case Clinical stage Clinical outcome |
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| 中文摘要: |
| 目的 了解手足口病重症病例临床分期与结局的特征及关联性，为建立临床重症病例评估方法提供依据。方法 根据地理位置、经济状况和疫情高发水平选择河南、山东、浙江、四川和云南省，随机抽取法定传染病报告中手足口病重症病例，收集病例人口学、临床资料和实验室检测结果等，按统一标准进行临床分期，分析各期病例构成、临床结局及其关联性。结果 共调查手足口病重症病例657例。实验室诊断病例357例，其中肠道病毒71型阳性病例326例，占91.3%（326/357）。临床分期：2期（神经系统受累期）病例542例、3期（心肺功能衰竭前期）病例99例、4期（心肺功能衰竭期）病例16例，分别占重症病例数的82.5%（95%CI：79.4%~85.3%）、15.1%（95%CI：12.4%~18.0%）、2.4%（95%CI：1.4%~3.9%）。11例有后遗症，占重症病例数的1.7%（95%CI：0.9%~3.0%）；8例死亡，病死率为1.2%（95%CI：0.6%~2.3%）。临床2、3和4期在各年龄组、5个省份、后遗症病例数、死亡例数的构成比差异均有统计学意义（分别为 χ2=22.632，P=0.012；χ2=41.481，P=0.000；χ2=12.960，P=0.001；χ2=16.850，P=0.001）。结论 手足口病重症病例临床分期与后遗症、死亡结局有关联性。临床分期可用于手足口病重症病例严重程度的评价。 |
| 英文摘要: |
| Objective To understand the characteristics and relation of clinical stage and outcome of severe cases on hand, foot and mouth disease (HFMD) and to establish the evaluation method for understanding severity of this disease. Methods According to factors as geographical location, economic and epidemic levels, five provinces (Henan, Shandong, Yunnan, Zhejiang and Sichuan provinces) were selected. Reported severe cases of HFMD from the National Notifiable Diseases Reporting System were selected randomly in the five provinces. Basic epidemiological information, clinical data, and pathogen testing results in the involved hospitals were collected. Clinical stages on all the patients were decided in accordance with “the clinical expert consensus on diagnosis and treatment for severe case of enterovirus type 71 (EV71) infections (2011 edition)”. Data were analyzed using SPSS software 18.0 and other epidemiological methods. Results A total of 657 severe HFMD cases were investigated, with 326 cases positive of EV71, accounting for 91.3% (326/357) among all the laboratory-confirmed cases. Of the 657 cases, 542 cases (82.5%, 95%CI: 79.4%-85.3%) were diagnosed as in stage 2 (with nervous system involvement), 99 cases (15.1%, 95%CI: 12.4%-18.0%) in stage 3 (early phase of function failure on heart and lung), and 16 cases (2.4%, 95%CI: 1.4%-3.9%) were in stage 4 (function failure of heart and lung). 11 cases (1.7%, 95%CI: 0.9%-3.0%) were with squeal when discharged from hospital with 8 cases (1.2%, 95%CI: 0.6%- 2.3%) died. When comparing the proportions among stage 2, stage 3 and stage 4, significant differences were found between age groups (χ2=22.632, P=0.012). The younger the patient was the lower the proportions of stage 2 and the more proportion of stage 3 appeared. When comparing the proportions of clinical stages among the five provinces, significant differences (χ2=41.481, P=0.000) were noticed. Proportions of different clinical stages in gender, ethnicity, occupation, place of residence types and the type of pathogen appeared no significant differences, respectively. However, the proportions of squeal and death in stage 2, stage 3 and stage 4 showed significant differences (sequela: χ2=12.960, P=0.001; Death: χ2=16.850, P=0.001), respectively. Conclusions The percentage of clinical stages of severe HFMD patients related to the rate of squeal and death. Clinical staging can be used for assessing the clinical severity of complications and the effectiveness of treatment, of HFMD. |
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