手足口病重症病例分析:基于全国手足口病监测试点数据

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

Abstract

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].Chinese journal of Epidemiology,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

Received:March 14, 2017

DOI：10.3760/cma.j.issn.0254-6450.2017.06.014

KeyWord: 手足口病重症病原学构成危险因素

English Key Word: Hand,foot and mouth disease Severe cases Aetiological structure Risk factors

FundProject:

Author Name	Affiliation	E-mail
Zheng Yaming	Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Chang Zhaorui	Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Jiang Lili	Yunnan Provincial Center for Disease Control and Prevention, Kunming 650011, China
Ji Hong	Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
Chen Guoping	Anhui Provincial Center for Disease Control and Prevention, Hefei 230601, China
Luo Ping	Shaoyang Center for Disease Control and Prevention, Shaoyang 422000, China
Pan Jingjing	Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
Tian Xiaoling	Inner Mongolia General Autonomous Region Center for Disease Control and Prevention, Hohhot 010031, China
Wei Leilei	Jilin Provincial Center for Disease Control and Prevention, Changchun 130062, China
Huo Da	Beijing Center for Disease Control and Prevention, Beijing 100013, China
Miao Ziping	Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China
Zou Xiaoni	Guangdong Maternal and Child Health Hospital, Guangzhou 517017, China
Chen Jianhua	Gansu Provincial Center for Disease Control and Prevention, Lanzhou 730000, China
Liao Qiaohong	Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China	liaoqh@chinacdc.cn

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Abstract:

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。

English Abstract:

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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