湖南省手足口病病例死亡的危险因素
호남성수족구병병례사망적위험인소
Risk factors of death cases of hand-foot-and-mouth disease in Hunan province
  • 万方数据
    中华预防医学杂志 중화예방의학잡지
    CHINESE JOURNAL OF
    2011年 10期 904-908 ,共5页

    徐巧华%高立冬%黄威%胡世雄%张帆%邓志红%刘富强%周帅锋%曾舸%杨浩

    서교화%고입동%황위%호세웅%장범%산지홍%류부강%주수봉%증가%양호

    手足口病%死亡%危险因素%Logistic模型 手足口病%死亡%危險因素%Logistic模型
    수족구병%사망%위험인소%Logistic모형
    Hand,foot and mouth disease%Death%Risk factors%Logistic models
    目的 分析湖南省致手足口病(HFMD)病例死亡的危险因素，为防控HFMD提供依据。方法 以2010年1-10月105例湖南省籍HFMD死亡病例作为病例组，以同期湖南省籍未死亡的HFMD重症病例作为对照组，按性别、居住地与病例组进行1：2匹配，共纳入210例对照。收集研究对象的基本信息、发病后就诊经过、既往疾病健康史等，应用单因素和多因素logistic回归分析相关危险因素。结果 病例组居住地构成分别为农村占79.05％ (83/105)、城乡结合占9.52％(10/105)，对照组分别为87.62％ (184/210)、11.43％ (24/210)；病例组初诊在村（个体）诊所、乡镇（社区）医院的分别有59.05％ (62/105)、20.00％( 21/105)，对照组分别有43.81％ (92/210)、13.33％(28/210)；病例组初诊诊断为HFMD的有22.86％( 24/105)，对照组有39.05％ (82/210)；病例组使用吡唑酮类退热药的有27.62％( 29/105)，对照组有7.14％ (15/210)；病例组在村（个体）诊所、乡镇（社区）医院使用糖皮质激素的分别有80.95％( 85/105)、5.71％ (6/105)，对照组分别有41.43％(87/210)、0.48％ (1/210)；病例组在村（个体）诊所、乡镇（社区）医院使用抗生素的分别有35.24％(37/105)、23.81％ (25/105)，对照组分别有15.71％ (33/210) 、7.14％ (15/210)；病例组在发病前1个月内接种疫苗的有3.81％(4/105)，对照组有11.90％ (25/210)。单因素logistic分析显示：居住地为农村（OR=0.075，95％CI:0.016～0.343）、居住地为城乡结合(OR=0.069，95％CI:0.013～0.368)、初诊诊断为HFMD（OR=0.463,95％ CI:0.271 ～0.788）、发病前1个月接种疫苗（OR=0.293,95％ CI:0.099～0.866）为保护因素；初诊为村（个体）诊所(OR= 4.717，95％ CI:1.891～11.767)、初诊在乡镇（社区）医院（OR= 5.250，95％ CI:1.883～14.641）、使用吡唑酮类退热药(OR=4.961，95％ CI:2.520 ～9.766)、村（个体）诊所使用糖皮质激素（OR=6.009,95％CI:3.435～10.510）、村（个体）诊所使用抗生素( OR=2.918，95％ CI:1.690～5.040)、乡镇（社区）医院使用糖皮质激素（OR= 12.667,95％ CI:1.505～106.638）、乡镇（社区）医院使用抗生素(OR=4.062,95％ CI:2.036～8.108)为危险因素。多因素logistic分析显示：使用吡唑酮类退热药(OR=2.311,95％CI:1.062 ～5.030)、村（个体）诊所使用糖皮质激素(OR =5.480,95％ CI:3.039～9.880)、村（个体）诊所使用抗生素( OR=2.430,95％ CI:1.301～4.538)、乡镇（社区）医院使用抗生素(OR=3.344,95％ CI:1.477 ～7.569)为HFMD死亡病例的危险因素。结论 使用吡唑酮类退热药、村（个体）诊所使用糖皮质激素、村级及乡镇级医疗机构使用抗生素为湖南省HFMD死亡病例发生的危险因素，有关部门应修订相关技术指南，规范上述药物的使用。
    목적 분석호남성치수족구병(HFMD)병례사망적위험인소，위방공HFMD제공의거。방법 이2010년1-10월105례호남성적HFMD사망병례작위병례조，이동기호남성적미사망적HFMD중증병례작위대조조，안성별、거주지여병례조진행1：2필배，공납입210례대조。수집연구대상적기본신식、발병후취진경과、기왕질병건강사등，응용단인소화다인소logistic회귀분석상관위험인소。결과 병례조거주지구성분별위농촌점79.05％ (83/105)、성향결합점9.52％(10/105)，대조조분별위87.62％ (184/210)、11.43％ (24/210)；병례조초진재촌（개체）진소、향진（사구）의원적분별유59.05％ (62/105)、20.00％( 21/105)，대조조분별유43.81％ (92/210)、13.33％(28/210)；병례조초진진단위HFMD적유22.86％( 24/105)，대조조유39.05％ (82/210)；병례조사용필서동류퇴열약적유27.62％( 29/105)，대조조유7.14％ (15/210)；병례조재촌（개체）진소、향진（사구）의원사용당피질격소적분별유80.95％( 85/105)、5.71％ (6/105)，대조조분별유41.43％(87/210)、0.48％ (1/210)；병례조재촌（개체）진소、향진（사구）의원사용항생소적분별유35.24％(37/105)、23.81％ (25/105)，대조조분별유15.71％ (33/210) 、7.14％ (15/210)；병례조재발병전1개월내접충역묘적유3.81％(4/105)，대조조유11.90％ (25/210)。단인소logistic분석현시：거주지위농촌（OR=0.075，95％CI:0.016～0.343）、거주지위성향결합(OR=0.069，95％CI:0.013～0.368)、초진진단위HFMD（OR=0.463,95％ CI:0.271 ～0.788）、발병전1개월접충역묘（OR=0.293,95％ CI:0.099～0.866）위보호인소；초진위촌（개체）진소(OR= 4.717，95％ CI:1.891～11.767)、초진재향진（사구）의원（OR= 5.250，95％ CI:1.883～14.641）、사용필서동류퇴열약(OR=4.961，95％ CI:2.520 ～9.766)、촌（개체）진소사용당피질격소（OR=6.009,95％CI:3.435～10.510）、촌（개체）진소사용항생소( OR=2.918，95％ CI:1.690～5.040)、향진（사구）의원사용당피질격소（OR= 12.667,95％ CI:1.505～106.638）、향진（사구）의원사용항생소(OR=4.062,95％ CI:2.036～8.108)위위험인소。다인소logistic분석현시：사용필서동류퇴열약(OR=2.311,95％CI:1.062 ～5.030)、촌（개체）진소사용당피질격소(OR =5.480,95％ CI:3.039～9.880)、촌（개체）진소사용항생소( OR=2.430,95％ CI:1.301～4.538)、향진（사구）의원사용항생소(OR=3.344,95％ CI:1.477 ～7.569)위HFMD사망병례적위험인소。결론 사용필서동류퇴열약、촌（개체）진소사용당피질격소、촌급급향진급의료궤구사용항생소위호남성HFMD사망병례발생적위험인소，유관부문응수정상관기술지남，규범상술약물적사용。
    Objective To study risk factors of death cases of hand foot and mouth diseases (HFMD) in Hunan province, so as to provide scientific evidence for further prevention and control.Methods The 105 death cases of HFMD between January and October,2010 in Hunan Province were selected as case group; and the 210 survival cases of serious HFMD,which were matched by gender andresident places with a ratio at 2∶1 in the same period in Hunan were selected as control group. The basicinformation ,hospitalized experience and previous medical history had been surveyed and the relevant risk factors were analyzed by single factor and multi-factor logistic regression. Results In case group,79.05％(83/105) of the cases lived in rural area and 9.52％ (10/105) of the cases lived in urban-rural midst area. In control group,87. 62％ (184/210) of the cases lived in rural area and 11.43％ (24/210) of the cases lived in urban-rural midst area. In case group,59.05％ (62/105) of the patients first visited rural (private) clinics and 20. 00％ (21/105) first visited community hospitals in villages and towns; while in control group,43. 81％ (92/210) and 13. 33％ ( 28/210 ) chose rural (private) clinics and community hospitals in villages and towns as the first choice respectively. 22. 86％ ( 24/105 ) of the case group and 39. 05％ (82/210) of the control group were diagnosed as HFMD in their first visit to hospital. 27.62％(29/105) of the case group and 7. 14％ (15/210) in control group were provided pyrazolone in the treatment. For glucocorticoid,80. 95％ ( 85/105 ) and 5.71％ (6/105) of the case group were given as treatment by rural(private) clinics and community hospitals in villages and towns separately; while the proportions in the control group were 41.43％ (87/210) and 0. 48％ (1/210) respectively. For antibiotics,35.24％ ( 37/105 ) and 23. 81％ (25/105) of the case group were prescribed by rural (private) clinics and community hospitals in villages and towns separately; while the percentages in the control group were 15. 71％ (33/210) and 7.14％ (15/210). 3.81％ (4/105) of the case group and 11.90％ (25/210) of the control group were vaccinated in one month before the onset. The results of single-factor logistic regression indicated that living in rural areas( OR = 0. 075,95％ CI:0. 016 - 0. 343 ) and in rural-urban midst areas ( OR = 0. 069,95％ CI: 0. 013 - 0. 368 ), diagnosis of HFMD in the first visit to hospital ( OR = 0. 463,95 ％ CI:0. 271 - 0. 788 ) and vaccination one month before the onset ( OR = 0. 293,95 ％ CI :0. 099 - 0. 866 )were four protective factors; while rural (private) clinics as the first choice ( OR = 4. 717,95 ％ CI: 1. 891 -11. 767),community hospital in villages and towns as the first choice (OR = 5. 250,95％CI: 1. 883 -14. 641 ), medication of pyrazolone ( OR = 4. 961,95％ CI: 2. 520 - 9. 766 ), medication of glucocorticoid in rural(private) clinics (OR = 6. 009,95％ CI:3. 435- 10. 510) and in community hospital in villages and towns( OR = 12. 667,95％ CI: 1. 505 - 106. 638 ), medication of antibiotics in rural (private) clinics ( OR =2. 918,95％ CI: 1. 690 - 5. 040) and in community hospital in villages and towns ( OR = 4. 062,95％ CI:2.036- 8. 108 ) were seven risk factors. The results of multi-factors logistic regression showed that medication of pyrazolone ( OR = 2. 311,95％ CI: 1. 062 - 5. 030 ), medication of glucocorticoid in rural (private) clinics ( OR = 5.480,95 ％ CI:3.039 - 9. 880 ), medication of antibiotics in rural (private) clinics (OR =2. 430,95％ CI:1.301 -4. 538) and medication of antibiotics in community hospitals in villages and towns( OR = 3. 344 ,95％ CI: 1. 477 -7.569) were the risk factors of death of HFMD. ConclusionThe risk factors of HFMD deaths include the medication of pyrazolone, glucocorticoid and antibiotics by rural (private) clinics and medical institutions in villages and towns. The department concerned should revise the technical manual to standardize the medication of the above drugs.
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