不同年龄组儿童手足口病重症病例死亡风险分析

摘要:目的　分析不同年龄手足口病重症病例死亡的危险因素，为制定综合防治措施、降低手足口病病死率提供依据。方法　收集湖南省2012年手足口病重症病例及重症后死亡病例基本特征、就诊过程、临床症状及病原学等资料。以死亡为观察结局，采用Logistic回归方法分析影响不同年龄手足口重症病例死亡的影响因素。结果　对＜2岁组的病例，“照看人文化程度低”（OR＝2.58）和“EV71病毒”（OR＝7.36）明显增加重症病例的死亡风险；“初诊为手足口病”（OR＝0.33）及“发病时出疹”（OR＝0.27）会降低该组儿童的死亡风险。对≥2岁组的病例，“头痛”（OR＝13.84）和“同伴发病”（OR＝3.63）会增加该组重症病例的死亡风险；“发病时出疹”（OR＝0.14）也被观察到能明显降低该组死亡风险。以上的OR值经统计学检验，均有统计学显著性（P＜0.05）。结论　加强监护人及基层医疗人员对手足口病的识别能力，可能有效改善重症患者的预后，降低死亡风险。此外，对＜2岁的患者应加强病原学监测，重视EV71病毒感染病例的早诊早治。

Analysis of the mortality risk of severe cases of hand-foot-and-mouth disease among children of different age groups

Abstract: Objective The study analyzed the risk factors for death among severe cases of hand-foot-and-mouth disease (HFMD) of different age groups, aiming to provide a reference for developing comprehensive control measures and reducing the mortality of HFMD. Methods Data on basic characteristics, medical history, clinical symptoms, and etiology of severe and death cases of HFMD in Hunan Province in 2012 were collected. With death being the observation outcome, Logistic regression was applied to analyze the influencing factors for death among HFMD patients of different ages. Results For patients under the age of 2, low education level of care givers (OR=2.58) and infection with EV71 virus (OR=7.36) significantly increased the mortality risk of severe cases; and correct diagnosis at first visit (OR=0.33) and having rashes (OR=0.27) reduced the mortality risk. For patients over the age of 2, having headache (OR=13.84) and contact with HFMD patients (OR=3.63) increased the mortality risk; and having rashes (OR=0.14) also reduced the mortality risk. All of the OR values were statistically significant (P<0.05). Conclusion Enhancing the ability of guardians and frontline medical personnel in identifying HFMD may improve prognosis of severe patients and reduce mortality risk effectively. In addition, etiological surveillance of patients under the age of 2 should be strengthened, and early diagnosis and treatment of EV71-infected patients should be emphasized.