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目的:探讨肠道病毒71型(enterovirus A group 71 type, EV-A71)疫苗上市前重症手足口病(hand, foot and mouth disease, HFMD)中枢神经系统(central nervous system, CNS)并发症的类型、严重程度，为重症HFMD临床演变提供基础数据。方法:采用描述性分析对2010—2016年南京市儿童医院、苏州大学附属儿童医院、无锡市人民医院、徐州市儿童医院报告的3 583例实验室确诊的重症HFMD的一般情况、临床表现、实验室指标进行统计，应用Logistic回归筛选增加HFMD严重程度的预警指标。结果:重症HFMD病死率为8.09‰(29/3 583)，入住儿科重症监护室(pediatric intensive care unit, PICU)率为11.75%(421/3 583)，出院未愈的发生率为5.30‰(19/3 583)，其中CNS并发症轻微组占39.02%(1 398/3 583)，严重组占59.22%(2 122/3 583)，危重组占1.76%(63/3 583)。危重组发病年龄在6～11月龄、不典型疹、呼吸系统症状/体征(气急、呼吸减慢、呼吸困难等)、神经系统症状/体征(手足抖动、抽搐、嗜睡、昏睡等)、循环系统症状/体征(心率加快、皮肤颜色异常、心律失常、四肢发凉等)、实验室检查(白细胞计数升高、淋巴细胞计数升高、血小板计数升高、C反应蛋白升高等)、临床辅助检查(脑电图、脑CT、胸片X线)等指标发生率在危重组高于其他2组，且有统计学差异(n P<0.05)。Logistic回归模型显示：呼吸减慢、呕吐、脑膜刺激征等11个变量随着异常比例增大，CNS并发症严重程度升高(n P<0.05)。n 结论:易惊、呼吸减慢、呕吐、淋巴细胞升高、脑电图异常等指标对于重症HFMD患儿进展为不同严重程度的CNS并发症具有重要的临床意义。“,”Objective:To explore the type distribution and severity of central nervous system(CNS) complications in severe hand, foot and mouth disease (HFMD) cases prior to the introduction of human enterovirus A group 71 type (EV-A71) vaccine, and provide scientific data for early clinical intervention.Methods:A total of 3 583 laboratory-confirmed severe HFMD cases in Jiangsu province during 2010-2016 were collected and analyzed retrospectively. Related early warning signs of increased HFMD severity were estimated with logistic regression analyses.Results:The severity-fatality rate, severity-pediatric intensive care unit(PICU) admission rate, and sequelae rate were 8.09‰(29/3 583), 11.75% (421/3 583)and 5.30‰(19/3 583). Of them, 39.02% (1 398/3 583) patients suffered from mild CNS involvement, 59.22% (2 122/3 583) patients suffered from severe CNS involvement, 1.76%(63/3 583) suffered from critical CNS involvement. The rates of the cases whose age of onset was 6-11 months, the rates of cases with atypical rash, respiratory-related signs and symptoms (shortness of breath, slowed breathing, dyspnea, etc), neurological-related signs and symptoms [(hand and foot shaking, convulsions, lethargy(sleepiness), etc], circulatory-related system signs and symptoms (faster heart rate, abnormal skin color, arrhythmia, cold limbs), laboratory-related indicators (increased white blood cell count, increased lymphocyte count, increased platelet count, increased C-reactive protein, etc), clinical auxiliary examination [electroencephalogram(EEG), brain CT, chest X-ray)] were highest in the critical CNS involvement group, and the differences were significant (n P<0.05). Multivariate logistic regression analysis showed that with the increase of proportion of convulsions, slowed breathing, vomiting, meningeal irritation and other 7 variables, the severity of CNS complications increased (n P<0.05).n Conclusions:The indicators such as easily startled, slow breathing, vomiting, elevated lymphocytes, abnormal EEG and other indicators have important clinical significance for children with severe HFMD to progress to CNS complications of different severity.