Zhang J, Jin Y, Sun J L, Wang Y X, Wang X J, Fu X Q, Miao Z P, Lyu J
Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
Division of Infectious Disease, Taizhou City Center for Disease Control and Prevention, Taizhou 318000, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2017 May 10;38(5):651-655. doi: 10.3760/cma.j.issn.0254-6450.2017.05.019.
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. 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. A total of657 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: 79.485.3) were diagnosed as in stage 2 (with nervous system involvement), 99 cases (15.1, 95: 12.418.0) in stage 3 (early phase of function failure on heart and lung), and 16 cases (2.4, 95: 1.43.9) were in stage 4 (function failure of heart and lung). 11 cases (1.7, 95: 0.93.0) were with squeal when discharged from hospital with 8 cases (1.2, 95: 0.62.3) died. When comparing the proportions among stage 2, stage 3 and stage 4, significant differences were found between age groups ((2)=22.632, =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 ((2)=41.481, =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: (2)=12.960, =0.001; Death: (2)=16.850, =0.001), respectively. 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.
了解手足口病（HFMD）重症病例的临床特征、临床分期与预后的关系，建立判断本病严重程度的评估方法。根据地理位置、经济及疫情水平等因素，选取河南、山东、云南、浙江和四川5个省份。从全国法定传染病报告系统中随机抽取5省报告的HFMD重症病例，收集相关医院的基本流行病学资料、临床资料及病原学检测结果。所有患者的临床分期依据《肠道病毒71型（EV71）感染重症病例临床诊断和治疗专家共识（2011年版）》确定。采用SPSS 18.0软件及其他流行病学方法进行数据分析。共调查657例HFMD重症病例，其中326例EV71阳性，占所有实验室确诊病例的91.3%（326/357）。657例中，542例（82.5%，95%CI：79.4%85.3%）诊断为第2期（神经系统受累），99例（15.1%，95%CI：12.4%18.0%）为第3期（心肺功能衰竭早期），16例（2.4%，95%CI：1.4%3.9%）为第4期（心肺功能衰竭）。11例（1.7%，95%CI：0.9%3.0%）出院时有后遗症，8例（1.2%，95%CI：0.6%~2.3%）死亡。比较第2期、第3期和第4期的构成比，各年龄组间差异有统计学意义（χ²=22.632，P=0.012），年龄越小，第2期构成比越低，第3期构成比越高。比较5省临床分期的构成比，差异有统计学意义（χ²=41.481，P=0.000）。不同临床分期在性别、民族、职业、居住类型及病原类型方面的构成比差异无统计学意义。但第2期、第3期和第4期的后遗症和死亡构成比差异有统计学意义（后遗症：χ²=12.960，P=0.001；死亡：χ²=16.850，P=0.001）。HFMD重症患者的临床分期与后遗症率和死亡率相关。临床分期可用于评估HFMD并发症的临床严重程度及治疗效果。
