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【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。
【Objective】 To investigate the risk factors of HFMD in Hubei Province from 2010 to 2012 and provide scientific basis for the prevention and control of HFMD. 【Methods】 The cases of HFMD in Hubei Province during 2010-2012 were selected as the case group. A total of 63 cases were randomly divided into two groups according to the ratio of 1: 3. A total of 189 cases of non-death HFMD in the same period were collected from Hubei Province as control group . Collecting the basic information of the subjects, post-illness diagnosis, clinical symptoms and laboratory test results and other information, the use of SPSS software for Logistic regression analysis. 【Results】 The results of single factor Logistic analysis showed that the first diagnosis was HFMD and rash as protective factors; the age was less than 1 year old, the place of residence was rural and breastfeeding. The newly diagnosed hospitals were village and township level medical institutions, Class drugs, the use of antibiotics, EV71 positive are risk factors. Multivariate logistic analysis showed that the newly diagnosed hand-foot-mouth disease (OR = 0.276, 95% CI: 0.082-0.937) was a protective factor for the death of hand-foot-mouth disease. The age less than 1 year (OR = 8.222, 95% CI: (OR = 3.459, 95% CI: 1.051-11.388), breastfeeding (OR = 2.451, 95% CI: 1.013-5.928) and EV71 (OR = 7.964, 95% CI : 2.504 ~ 25.330) are the risk factors of hand-foot-mouth disease death. 【Conclusion】 To prevent the development of hand-foot-mouth disease in children, we should improve the early diagnosis ability of medical institutions and carry out molecular detection of pathogens to strengthen education in rural areas. At the same time, we pay close attention to children with younger age and EV71 infection.