摘要
目的手足口病重症病例的早期识别对于临床治疗意义重大。本研究旨在探讨手足口病重症病例的影响因素,为临床早期识别治疗提供科学依据。方法收集2010-01-01-2018-04-30中国期刊全文数据库、万方数据库公开发表的关于手足口病重症病例影响因素研究文献,采用Review Manager 5进行Meta分析。纳入标准包括病例对照研究、暴露的定义和赋值类似、研究假设和研究方法基本相同、诊断标准明确且相似、提供或可以转化OR值和95%可信区间(95%CI)等,排除标准主要是非病例对照研究、以特定年龄范围内的人群为研究对象、危重型手足口病及死亡病例相关影响因素研究、质量低下、信息数据不全及统计方法错误且不能修正的文献。结果纳入分析文献19篇,累计病例组11788例,对照组95916例。年龄≤3岁(OR=2.99,95%CI为2.73~6.42,P<0.001)、发病至入院时间≥3d(OR=8.51,95%CI为7.10~10.22,P<0.001)、EV71感染(OR=5.33,95%CI为1.69~16.79,P<0.001)、精神状态差(OR=74.63,95%CI为25.32~219.98,P<0.001)、体温>39℃(OR=2.23,95%CI为2.11~4.93,P<0.001)、热程≥3d(OR=5.39,95%CI为4.68~6.21,P<0.001)、空腹血糖≥9mmol/L(OR=34.68,95%CI为20.76~57.92,P<0.001)、初诊单位县级以下(OR=11.46,95%CI为6.63~19.82,P<0.001)和白细胞计数升高(OR=7.04,95%CI为3.87~9.43,P<0.001)是手足口病重症患者影响因素。敏感性分析结果显示,EV71感染、精神状态差2个因素合并结果不稳定,其余影响因素合并OR值结果稳定。EV71感染存在发表偏倚,其余影响因素无发表偏倚。结论年龄≤3岁、发病至入院时间≥3d、EV71感染、精神状态差、体温>39℃、热程≥3d、空腹血糖≥9mmol/L、初诊医院县级以下及白细胞计数升高是手足口病重症病例发病的主要影响因素。
OBJECTIVE Early identification of severe cases of hand-foot-mouth disease is of great significance for clinical treatment.This article aims to explore the influencing factors of severe cases of hand-foot-mouth disease and provide a scientific basis for early clinical identification and treatment.METHODS The research literature on the influencing factors of severe cases of hand,foot and mouth disease published in the Chinese Journal Full-text Database and Wanfang Journal Database from January 1,2010 to April 30,2018 were collected.Inclusion criteria include that the study is a casecontrol study,the definition and assignment of exposure are similar,the research hypotheses and research methods are basically the same,the diagnostic criteria are clear and similar,that the ORvalue and 95%confidence interval(95%CI)are provided or can be transformed,etc.The exclusion criteria are mainly non-case-control studies,research on populations within a certain age range,studies on influencing factors of critical hand-foot-mouth disease and death cases,poor quality,incomplete information and data,incorrect statistical methods and uncorrectable literature.RESULTS Nineteen articles were included in the analysis,with a total of 11788 cases in the case group and 95916 cases in the control group.Age≤3 years(OR=2.99,95%CI:2.73-6.42,P<0.001),time from onset to admission≥3 d(OR=8.51,95%CI:7.10-10.22,P<0.001),EV71 infection(OR=5.33,95%CI:1.69-16.79,P<0.001),poor mental state(OR=74.63,95%CI:25.32-219.98,P<0.001),body temperature>39℃(OR=2.23,95%CI:2.11-4.93,P<0.001),heat course≥3 d(OR=5.39,95%CI:4.68-6.21,P<0.001),fasting blood glucose≥9 mmol/L(OR=34.68,95%CI:20.76-57.92,P<0.001),the initial diagnosis unit is below the county level(OR=11.46,95%CI:6.63-19.82,P<0.001)andthe white blood cell count(OR=7.04,95%CI:3.87-9.43,P<0.001)were the influencing factors of severe hand,foot and mouth disease.After sensitivity analysis,the combined result of the two factors of EV71 infection and poor mental state was unstable,and the results of the combined ORvalues of the remaining influencing factors were stable.There is publication bias in EV71 infection,and there is no publication bias in other influencing factors.CONCLUSION Age≤3 years old,duration onset to admission≥3 d,EV71 infection,with drawnness and lethargy,degree of fever>39℃duration fever≥3 days,fasting blood-glucose≥9 mmol/L,community hospital or individual clinic for the first visit and increased peripheral white blood cell count were the influence factors of the patients with severe HFMD.
作者
薛爱丽
李晓红
赵炜
刘晓红
XUE Ai-li;LI Xiao-hong;ZHAO Wei;LIU Xiao-hong(Department of Pediatrics,Qingdao Women's and Children's Hospital,Qingdao 266034,P.R.China)
出处
《社区医学杂志》
2020年第17期1234-1240,共7页
Journal Of Community Medicine
关键词
手足口病重症病例
EV71感染
热程
早期识别
META分析
severe cases of hand,foot and mouth disease
EV71 infection
fever course
early recognition
Meta analysis
