文章摘要
郑亚明,常昭瑞,姜黎黎,嵇红,陈国平,罗平,潘静静,田晓灵,魏雷雷,霍达,缪梓萍,邹晓妮,陈建华,廖巧红.手足口病重症病例分析:基于全国手足口病监测试点数据[J].中华流行病学杂志,2017,38(6):759-762
手足口病重症病例分析:基于全国手足口病监测试点数据
Severe cases with hand, foot and mouth disease:data based on national pilot hand, foot and mouth disease surveillance system
收稿日期:2017-03-14  出版日期:2017-06-19
DOI:10.3760/cma.j.issn.0254-6450.2017.06.014
中文关键词: 手足口病  重症  病原学构成  危险因素
英文关键词: Hand,foot and mouth disease  Severe cases  Aetiological structure  Risk factors
基金项目:
作者单位E-mail
郑亚明 102206 北京, 中国疾病预防控制中心传染病预防控制处传染病监测预警国家重点实验室  
常昭瑞 102206 北京, 中国疾病预防控制中心传染病预防控制处传染病监测预警国家重点实验室  
姜黎黎 650011 昆明, 云南省疾病预防控制中心急传所  
嵇红 210009 南京, 江苏省疾病预防控制中心急传所  
陈国平 230601 合肥, 安徽省疾病预防控制中心  
罗平 422000 湖南省邵阳市疾病预防控制中心  
潘静静 450016 郑州, 河南省疾病预防控制中心  
田晓灵 010031 呼和浩特, 内蒙古自治区疾病预防控制中心  
魏雷雷 130062 长春, 吉林省疾病预防控制中心  
霍达 100013 北京市疾病预防控制中心  
缪梓萍 310051 杭州, 浙江省疾病预防控制中心  
邹晓妮 517017 广州, 广东省妇幼保健院  
陈建华 730000 兰州, 甘肃省疾病预防控制中心  
廖巧红 102206 北京, 中国疾病预防控制中心传染病预防控制处传染病监测预警国家重点实验室 liaoqh@chinacdc.cn 
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中文摘要:
      目的 了解手足口病重症病例的患病情况、病原构成以及危险因素。方法 对2015年11月1日至2016年11月30日全国手足口病监测试点网络直报系统报告的1 489例手足口病重症及死亡病例进行研究,对基本信息、就诊及治疗情况、临床严重程度及病原构成进行描述性分析并通过多项logistic逐步回归分析重症病例治疗结果的危险因素。结果 1 489例重症病例中有7例死亡病例。960例(72.9%)年龄<3岁,937例(62.9%)为男性,病例大部分居住于农村(63.9%)。494例(33.2%)患者首次就诊时选择村级和乡镇级机构。重症病例的发病-就诊、发病-诊断为手足口病和发病-重症诊断的时间间隔分别为0(0~1) d、1(0~2) d和2(1~4) d。并发症有无菌性脑膜炎(51.9%,773例)、非脑干脑炎(25.3%,377例)、脑干脑炎(17.5%,260例)、脑脊髓炎(0.4%,6例)、急性弛缓性麻痹(0.1%,1例)、肺水肿/肺出血(0.3%,4例)和心肺功能衰竭(4.6%,68例)。1 217例纳入病原分析的重症及死亡病例的病原构成依次为肠道病毒(EV)71(52.8%,642例)、其他肠道病毒(21.5%,261例)、柯萨奇病毒(Cox) A16(3.0%,36例)、EV71和Cox A16合并感染(0.1%,1例)。并发症(Z=3.15,P=0.002)和发病-重症诊断的时间(Z=3.95,P<0.001)为治疗结果的危险因素。结论 手足口病重症病例以农村男童为主,并发症以无菌性脑膜炎、非脑干脑炎和脑干脑炎为主。EV71是重症及死亡病例的重要病原构成。确诊的及时性以及并发症类型对于治疗结果具有重要影响。
英文摘要:
      Objective To investigate the clinical severity, etiological classification and risk factors of severe cases with hand, foot and mouth disease (HFMD). Methods A total of 1 489 records on severe and fatal HFMD cases reported to the national pilot surveillance system of HFMD were used to analyze the demographic, medical treatment, etiological classification of the cases. Treatment outcome related risk factors were also studied with multi-variable stepwise logistic regression method. Results Seven out of the 1 489 severe HFMD cases died of this disease. A total of 960 (72.9%) were under three years old and 62.9% were male and most of the cases (937, 62.9%) resided in rural areas. Among all the cases, 494 (33.2%) went to seek the first medical assistance at the institutions of village or township level. Durations between disease onset and first medical attendance, being diagnosed as the disease or diagnosed as severe cases were 0(0-1) d, 1 (0-2) d and 2 (1-4) d, respectively. In total, 773 (51.9%) of the severe HFMD cases were diagnosed as with aseptic meningitis, 260 (17.5%) with brainstem encephalitis, 377 (25.3%) with non-brainstem encephalitis, 6 (0.4%) with encephalomyelitis, 1 (0.1%) with acute flaccid paralysis, 4 (0.3%) with pulmonary hemorrhage/pulmonary edema and 68 (4.6%) with cardiopulmonary failure. Of the etiologically diagnosed 1 217 severe and fatal HFMD cases, 642 (52.8%) were with EV71, other enterovirus 261 (21.5%), Cox A16 36 (3.0%), 1 (0.1%) with both EV71 and Cox A16. However, 277 (22.8%) showed negative on any pathogenic virus. Complication (Z=3.15, P=0.002) and duration between onset and diagnosed as severe cases (Z=3.95, P<0.001) were shown as key factors related to treatment outcomes. Conclusions Most severe HFMD cases appeared in boys, especially living in the rural areas. Frequently seen complications would include aseptic meningitis, non-brainstem encephalitis and brainstem encephalitis. EV71 was the dominant etiology for severe and fatal cases. Early diagnosis and complication control were crucial, related to the treatment outcome of HFMD.
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