Abstract: Objective To explore the risk factors associated with death cases of hand-foot-mouth disease(HFMD) in Hubei Province 2010-2012,so as to provide a scientific evidence for its prevention and control. Methods The 63 death cases of HFMD between 2010 and 2012 in Hubei Province were selected as case group,and the 189 survival cases of serious HFMD,which were randomly selected with a ratio at 3∶1 in the same period in Hubei as control group.The basic information,hospitalized experience,clinical symptoms and laboratory test results had been surveyed and the relevant risk factors were analyzed by single factor and multi-factor Logistic regression. Results The results of single-factor Logistic regression indicated that diagnosis of HFMD in the first visit to hospital and rash were two protective factors.While age less than 1 year old,living in rural areas,breastfeed,rural clinics and township medical institutions as the first choice,medication of hormone,medication of antibiotics and EV71 infection were nine risk factors.The results of multi-factors Logistic regression showed that diagnosis of HFMD in the first visit to hospital(OR=0.276,95%CI:0.082~0.937)were protective factors of death of HFMD.Age less than 1 year old(OR=8.222,95%CI:1.875~36.046),living in rural areas(OR=3.459,95%CI:1.051~11.388),breastfeed(OR=2.451,95%CI:1.013~5.928)and EV71 infection(OR=7.964,95%CI:2.504~25.330)were the risk factors of death of HFMD. Conclusions It is necessary to improve the capacity of clinical diagnosis,together with improvement molecular diagnosis for identifying the virus type of HFMD in order to diagnose the HFMD cases earlier.More attention should be paid to these HFMD severe cases with age less than 1 year old and EV71 infection as well as strengthened rural area knowledge propaganda and education.

Key words: hand-foot-mouth disease, death, risk factors, Logistic models

摘要： 目的 研究湖北省2010-2012年手足口病死亡病例的危险因素,为预防和控制手足口病提供科学依据。 方法 以湖北省2010-2012年间手足口病死亡病例为病例组,共63例;按照1∶3的比例随机在湖北省抽取189例同期监测录入的非死亡手足口病重症病例为对照组。收集研究对象的基本情况、发病后就诊情况、临床症状及实验室检测结果等信息,使用SPSS软件进行Logistic回归分析。 结果 单因素Logistic分析结果显示:初次诊断为手足口病和出疹为保护因素;年龄＜1岁、现居住地为农村、母乳喂养、初诊医院为村级和乡级医疗机构、使用激素类药物、使用抗生素类药物、EV71阳性均为危险因素。多因素Logistic分析结果显示:初诊诊断为手足口病(OR=0.276,95%CI:0.082~0.937)为手足口病死亡病例的保护性因素;年龄＜1岁(OR=8.222,95%CI:1.875~36.046)、现居住地为农村(OR=3.459,95%CI:1.051~11.388)、母乳喂养(OR=2.451,95%CI:1.013~5.928)及EV71阳性(OR=7.964,95%CI:2.504~25.330)为手足口病死亡病例的危险因素。 结论 防范手足口病患儿发展为死亡,应提高医疗机构的早期诊断能力并且开展病原分子检测,加强农村区域相关知识宣教,同时对低龄、EV71感染的患儿给予密切关注。

关键词: 手足口病, 死亡, 危险因素, Logistic模型