Pan Hao, Zheng Ya-xu, Mao Sheng-hua, Hu Jia-yu, Zheng Yang, Li Jian, Huang Pu, Cheng Hua, Wu Huan-yu
Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2012 Aug;33(8):763-7.
To explore the factors associated with severe hand-food-mouth disease (HFMD) case in Shanghai.
A total of 105 severe HFMD cases diagnosed from May to July, 2011 in Shanghai were enrolled as case group while another 210 mild HFMD cases were randomly selected as control group in the same period. All subject's parents or babysitters were asked to fill in the questionnaire in which including demography, ways of babysitting, behavior and the like. All HFMD cases were diagnosed by both clinical symptom and nuclear acid testing. Data was processed by EpiData (V3.0) and analyzed by SPSS (V17.0).
Factors as age, gender, Diaspora pattern, migrant, size of house, numbers of family member, numbers of children, frequency of seeing doctor, dishware that sharing with babysitter, food chewed by babysitter, dirty hand, EV71 virus type and diagnosis on HFMD in the fist visit to hospital were found associated with severe HFMD by univariate analysis.
through multivariate logistic regression showed that factors including: being the only male kid, more than 3 children in the family, dirty hands, unable to be diagnosed as HFMD in the first visit to the hospital, visiting doctor during the past 6 months for 2 and 3 times etc. could be kept in the model with statistical threshold of 0.05. Adjusted ORs and confidence intervals of them were 2.431 (1.317 - 4.487), 2.661 (1.332 - 5.315), 3.403 (1.871 - 6.191), 6.607 (3.011 - 14.500), 2.431 (1.111 - 5.321), 2.628 (1.137 - 6.071) respectively. Being Infected by EV71 was also found a very important risk factor compared with CoxA16 or other enteroviruses, and its adjusted OR was 5.614 (2.409 - 13.082).
It was necessary to implement molecular diagnosis for identifying the virus type of HFMD, together with improvement on the capacity of clinical diagnosis in order to diagnose the HFMD cases earlier. More attention should be paid to these HFMD cases with EV71 infection as well as prompting frequent visits to hospitals on those families with more children.
探讨上海市重症手足口病病例的相关影响因素。
选取2011年5月至7月在上海确诊的105例重症手足口病病例作为病例组，同期随机选取210例轻症手足口病病例作为对照组。所有研究对象的父母或保姆均需填写问卷，内容包括人口统计学信息、照料方式、行为习惯等。所有手足口病病例均通过临床症状及核酸检测确诊。数据采用EpiData（V3.0）录入，SPSS（V17.0）进行分析。
单因素分析发现，年龄、性别、居住模式、是否为流动人口、住房面积、家庭成员数量、孩子数量、就诊频率、与保姆共用餐具、保姆嚼食食物、手部不清洁、肠道病毒71型（EV71）感染以及首次就诊时手足口病的诊断情况等因素与重症手足口病有关。
多因素Logistic回归分析显示，包括家中唯一男孩、家庭中孩子数量超过3个、手部不清洁、首次就诊时未诊断为手足口病、过去6个月内就诊2次及3次等因素可纳入模型，统计检验水准为0.05。其调整后的比值比（OR）及95%置信区间分别为2.431（1.317 - 4.487）、2.661（1.332 - 5.315）、3.403（1.871 - 6.191）、6.607（3.011 - 14.500）、2.431（1.111 - 5.321）、2.628（1.137 - 6.071）。与柯萨奇病毒A16型（CoxA16）或其他肠道病毒相比，感染EV71也是一个非常重要的危险因素，其调整后的OR为5.614（2.409 - 13.082）。
有必要开展分子诊断以明确手足口病的病毒类型，同时提高临床诊断能力以便更早地诊断手足口病病例。对于感染EV71的手足口病病例应给予更多关注，对孩子数量较多的家庭应督促其增加就诊频次。
