CAJ | 학술논문

目的：了解萍乡市手足口病（hand foot and mouth disease，HFMD）住院病例流行病学及临床特征。方法回顾性分析在萍乡市人民医院2011-2012年595例住院的 HFMD 患儿，分普通型与重型。应用 RT-PCR 进行人肠道病毒检测，并对住院病例的年龄、季节、分布区域、辅助检查、病情转归及相关因素进行分析。结果1）595例患儿中，普通型469例（75．25％）、重型126例（24．75％）。5岁以下儿童575例（99．64％），男女比例1．691。2）肠道病毒总阳性率为74．32％，混合感染率为0．39％；病毒检测以 EV71型、CoxA16型为主。不同年份检测类型差异有统计学意义（P ＜0．05）。3）本地区 HFMD 发病最高峰期以6-8月份，到9月、10月份又出现发病高峰趋势。4）辅助检查中，白细胞（WBC）、C 反应蛋白（CRP）部分升高，两型 WBC、CRP 升高差异无统计学意义（P ＞0．05）。心肌酶谱（CK-MB）、血糖（BG）都有不同程度升高，两型 CK-MB、BG 升高差异均有统计学意义（P ＜0．05）。5）单因素分析：重型病例发热持续时间、血清 CK-MB、血清 CRP 及血糖水平均高于普通病例（P ＜0．05）。将上述四因素纳入多元 logistic 回归方程分析发现，持续发热时间、血清 CK-MB、血糖水平为重症病例的独立预测危险因素（P ＜0．05）。结论本地区手足口病好发于5岁以下儿童，四季均可发病，发病高峰为6～10月份；病原感染主要为 EV71型及 CoxA16型，不同年份分型略有差异；发热持续时间、心肌酶谱及血糖水平是重型病例的独立预测因素。普通型患儿只要早诊断、早治疗、预后一般良好；重型病例具有一定死亡风险率。
목적：료해평향시수족구병（hand foot and mouth disease，HFMD）주원병례류행병학급림상특정。방법회고성분석재평향시인민의원2011-2012년595례주원적 HFMD 환인，분보통형여중형。응용 RT-PCR 진행인장도병독검측，병대주원병례적년령、계절、분포구역、보조검사、병정전귀급상관인소진행분석。결과1）595례환인중，보통형469례（75．25％）、중형126례（24．75％）。5세이하인동575례（99．64％），남녀비례1．691。2）장도병독총양성솔위74．32％，혼합감염솔위0．39％；병독검측이 EV71형、CoxA16형위주。불동년빈검측류형차이유통계학의의（P ＜0．05）。3）본지구 HFMD 발병최고봉기이6-8월빈，도9월、10월빈우출현발병고봉추세。4）보조검사중，백세포（WBC）、C 반응단백（CRP）부분승고，량형 WBC、CRP 승고차이무통계학의의（P ＞0．05）。심기매보（CK-MB）、혈당（BG）도유불동정도승고，량형 CK-MB、BG 승고차이균유통계학의의（P ＜0．05）。5）단인소분석：중형병례발열지속시간、혈청 CK-MB、혈청 CRP 급혈당수평균고우보통병례（P ＜0．05）。장상술사인소납입다원 logistic 회귀방정분석발현，지속발열시간、혈청 CK-MB、혈당수평위중증병례적독립예측위험인소（P ＜0．05）。결론본지구수족구병호발우5세이하인동，사계균가발병，발병고봉위6～10월빈；병원감염주요위 EV71형급 CoxA16형，불동년빈분형략유차이；발열지속시간、심기매보급혈당수평시중형병례적독립예측인소。보통형환인지요조진단、조치료、예후일반량호；중형병례구유일정사망풍험솔。
Objective To investigate the epidemiological and clinical characteristics of hand, foot,and mouth disease(HFMD)in children in Pingxiang.Methods Data of 595 children hospi-talized for common or severe HFMD in Pingxiang People’s Hospital between 2011 and 2012 were analyzed retrospectively.RT-PCR was used to detect human enterovirus.In addition,the age,sea-son,distribution area,auxiliary examination,disease outcome and related factors were analyzed. Results Among the 595 children,469(75.25%)had common HFMD and 126(24.75%)had se-vere HFMD.Moreover,575(99.64%)of 595 children were under 5 years old.The ratio of male to female was 1.69.The total positive rate and mixed infection rate of enterovirus were 74.32% and 0.39%,respectively.EV71 and CoxA16 were the two predominant pathogens causing HFMD,and pathogen types were significantly different between 2011 and 2012(P <0.05).The highest mor-bidity was found in the period from June to August.However,the tendency for peak morbidity was found in September and October.The auxiliary examination showed an increase in white blood cell(WBC)count,C-reactive protein(CRP),creatine kinase-MB(CK-MB)and blood glucose (BG).There were no significant differences in WBC and CRP levels between children with com-mon HFMD and children with severe HFMD(P >0.05).However,differences in CK-MB and BG levels were significant between children with common HFMD and children with severe HFMD (P <0.05).Univariate analysis showed that children with severe HFMD had longer duration of fever and higher levels of CK-MB,CRP and BG than children with common HFMD(P <0.05). Multivariate logistic regression analysis showed fever duration,serum CK-MB and BG were the independent risk factors for severe HFMD(P <0.05).Conclusion The HFMD occurs during the four seasons mostly in children under 5 years old.There is a peak in morbidity in the period from June to October.EV71 and CoxA16 are the two predominant pathogens causing HFMD,and pathogen types are significantly different among years.Fever duration,serum CK-MB and BG were the independent risk factors for severe HFMD.Early diagnosis and treatment can result in good prognosis in children with common HFMD.However,severe HFMD is associated with a cer-tain risk of death.