重症手足口病主要危险因素的Meta分析

doi:10.13481/j.1671-587x.20150517

吉林大学学报(医学版) ›› 2015, Vol. 41 ›› Issue (05): 974-979.doi: 10.13481/j.1671-587x.20150517

重症手足口病主要危险因素的Meta分析

冯慧芬¹, 赵秋民², 段广才³, 朱光¹

1. 郑州大学第五附属医院感染科, 河南郑州 450052;
2. 郑州大学学报编辑部, 河南郑州 450001;
3. 郑州大学公共卫生学院流行病学教研室, 河南郑州 450001

收稿日期:2015-02-02 出版日期:2015-09-28 发布日期:2015-09-29
通讯作者: 段广才,教授,博士研究生导师(Tel:0371-66916826,E-mail:gcduan@yeah.net) E-mail:gcduan@yeah.net
作者简介:冯慧芬(1972-),女,河南省郑州市人,副主任医师,医学博士,主要从事传染病流行病学方面的研究。
基金资助:
国家自然科学基金资助课题(81473030);河南省郑州市科技局技术研究与开发经费资助课题(141PPTGG440)

Main risk factors of severe hand-foot-mouth disease: A Meta-analysis

FENG Huifen¹, ZHAO Qiumin², DUAN Guangcai³, ZHU Guang¹

1. Department of Infectious Diseases, Fifth Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China;
2. Editorial Board of Journal of Zhengzhou University, Zhengzhou 450001, China;
3. Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China

Received:2015-02-02 Online:2015-09-28 Published:2015-09-29

摘要/Abstract

摘要：

目的:探讨重症手足口病(HFMD)的主要危险因素,为其早期识别、及时治疗提供参考依据。方法:应用Meta分析对1990-2014年国内外关于重症HFMD患者危险因素的病例-对照研究进行综合分析,经异质性检验,分别采用固定效应模型和随机效应模型进行相对危险度(OR)值合并,计算其95%可信区间(95%CI),并进行敏感性分析及发表偏倚评估。结果:共纳入文献19篇,病例(重症HFMD 患者)2 868例,对照(轻症HFMD 患者)6 676例。异质性检验,重症HFMD危险因素对应文献异质性检验I²值分别为,年龄≤3 岁 70%、居住地为农村0%、发病至入院时间≥3 d 23%、肠道病毒71型(EV71)感染75%、发热≥38.5℃ 0%、持续发热时间 ≥3 d 14%、精神萎靡0%、高血糖(≥6.11 mmol·L^-1)51%,各危险因素合并OR及其95%CI分别为2.90(2.14~3.94)、2.21(1.66~2.93)、2.02(1.46~2.79)、2.90(1.24~6.81)、3.13(1.99~4.94)、5.48(3.56~8.45)、4.25(2.45~7.37)和2.87(1.49~5.52)。敏感性分析,固定效应模型和随机效应模型计算结果一致。发表偏倚评估,无明显发表偏倚。结论: 农村低龄婴幼儿、就医延迟、EV71感染、持续高热、精神萎靡和血糖水平升高可能是重症HFMD患者发病的主要危险因素。

关键词: 重症手足口病, 病例-对照研究, Meta 分析, 危险因素

Abstract:

Objective To investigate the main risk factors of severe hand-foot-mouth disease (HFMD), and to provide the evidence for the prevention and treatment of HFMD. Methods The case-control studies on the risk factors of patients with severe HFMD from 1994 to 2014 were collected.Meta-analysis was performed to analyze the data.After the heterogeneity test,the fixed and random models were used to calculate the combined odds ratio (OR) and its 95% confidence interval (95%CI),then the sensitivity analysis was performed and the publish bias was evaluated. Results A total of 19 papers involving 2 868 cases (severe HFMD patients) and 6 676 controls (mild HFMD patients) were included in the review.The heterogeneity test results about I² was showed as follows:age ≤3 years was 70%,rural residence was 0%,duration onset to admission ≥3 d was 23%,enterovirus 71 (EV71) infection was 75%,degree of fever ≥38.5℃ was 0%,duration of fever ≥3 d was 14%,withdrawnness and lethargy was 0%, and hyperglycaemia (≥6.11 mmol·L^-1) was 51%.The pooled OR and 95%CI of the risk factors of severe HFMD were 2.90(2.14-3.3.94),2.21(1.66-2.93),2.02(1.46-2.79),2.90(1.24-6.81),3.13(1.99-4.94),5.48 (3.56-8.45),4.25(2.45-7.37),and 2.87(1.49-5.52). The sensitivity analysis showed that the results calculated by the fixed and random models were consistent.The publish bias evaluating results showed that there was no obvious publish bias. Conclusion The rural younger children,diagnosis and treatment delay,EV71 infection,high fever duration,withdrawnness and lethargy,and hyperglycemia might be the risk factors of the patients with severe HFMD.

Key words: severe hand-foot-mouth disease, case-control study, Meta-analysis, risk factor

中图分类号:

R512.5

冯慧芬, 赵秋民, 段广才, 朱光. 重症手足口病主要危险因素的Meta分析[J]. 吉林大学学报(医学版), 2015, 41(05): 974-979.

FENG Huifen, ZHAO Qiumin, DUAN Guangcai, ZHU Guang. Main risk factors of severe hand-foot-mouth disease: A Meta-analysis[J]. Journal of Jilin University Medicine Edition, 2015, 41(05): 974-979.

参考文献

[1] Xing W,Liao Q,Viboud C,et al. Hand,foot,and mouth disease in China,2008-12:an epidemiological study [J].Lancet Infect Dis,2014,14(4):308-318.

[2] Li X,Zhang X,Ding J,et al.Comparison between Chinese herbal medicines and conventional therapy in the treatment of severe hand,foot,and mouth disease:a randomized controlled trial [J].Evid Based Complement Alternat Med,2014,2014(4):140764.

[3] Jiang M,Wang XC.Clinical research of early,enough methylprednisone combined with immunoglobulin in treatment ofsevere hand-foot-mouth disease [J].Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi,2013,27(5):363-365.

[4] 吴淑莲,白珺.手足口病并发中枢神经系统感染危险因素的回顾性分析[J].广东医学,2011,32 (22):2976-2978.

[5] 汤奋扬,嵇红,李亮,等.儿童手足口病重症病例影响因素的病例对照研究[J].南京医科大学学报:自然科学版,2011,31(1):123-127.

[6] 张世英,王显军.聊城市手足口病重症病例流行病学特征及影响因素分析[J].现代预防医学,2013,40 (2):204-207.

[7] 刘鸣.系统评价Meta-分析设计与实施方法[M].北京:人民卫生出版社,2010:72-73.

[8] Duan GC,Yang HY,Shi LB,et al.Serum inflammatory cytokine levels correlate with handfoot-mouth disease severity:a nested serial case-control study [J].PLos One,2014,9(11):e112676.

[9] Ooi MH,Wong SC,Mohan A,et al.Identification and validation of clinical predictors for the risk of neurological involvement in children with hand,foot,and mouth disease in Sarawak [J].BMC Infect Dis,2009,9(3):1-12.

[10] Wang Q,Zhang WD,Zhang Y,et al.Clinical features of severe cases of hand,foot and mouth disease with EV71 virus infection in China [J].Clin Res,2014,3(6):510-516.

[11] 马晓梅,隋美丽,段广才,等.手足口病重症化危险因素 BP 神经网络模型预测分析[J].中国公共卫生,2014,30(6):758-761.

[12] Yang TC,Xu GZ,Dong HJ,et al.A case-control study of risk factors for severe hand-foot-mouth disease among children in Ningbo,China,2010-2011[J].Eur J Pediatr,2012,171(9):1359-1364.

[13] Pan JH,Chen MW,Zhang XZ,et al.High risk factors for severe hand,foot and mouth disease:a multicenter retrospective survey in Anhui province China,2008-2009 [J].Indian J Dermatol,2012,57(4):316-321.

[14] 刘丹,苏豪浩,王建红,等.手足口病重症病例的流行特征及危险因素[J].实用医学杂志,2013,29(6):995-998.

[15] Li YP,Dang SS,Deng HL,et al.Breastfeeding,previous Epstein-Barr virus infection,Enterovirus 71 infection,and rural residence are associated with the severity of hand,foot,and mouth disease [J].Eur J Pediatr,2013,172(5):661-666.

[16] Liu Z,Wang SK,Yang RS,et al.A case-control study of risk factors for severe hand-foot-mouth disease in Yuxi,China,2010-2012[J].Virol Sin,2014,29 (2):123-125.

[17] 吴寰宇,郑雅旭,毛盛华,等.上海市手足口病重症病例发病危险因素研究[J].环境与职业医学,2011,28(5):257-261.

[18] Zhou H,Guo SZ,Zhou H,et al.Clinical characteristics of hand,foot and mouth disease in Harbin and the prediction of severe cases [J].Chin Med J,2012,125(7):1261-1265.

[19] 孙建伟,许汴利,郭万申,等.手足口病重症病例危险因素探索与死亡病例特征分析[J].现代预防医学,2010,37(2):213-215.

[20] 石小华,胡静,喻文亮,等.648 例手足口病回顾性分析[J].南京医科大学学报:自然科学版,2010,30 (1):87-91.

[21] 施宗湖,唐柳平,杨振兴,等.柳州市某综合性医院重症手足口病危险因素研究[J].中华疾病控制杂志,2014,18 (10):960-963.

[22] Kim SJ,Kim JH,Kang JH,et al.Risk factors for neurologic complications of hand,foot and mouth disease in the republic of Korea,2009[J].J Korean Med Sci,2013,28(1):120-127.

[23] Li W,Teng GJ,Tong HF,et al.Study on risk factors for severe hand,foot and mouth disease in China [J].PLos One,2014,9:e87603.

[24] 李幸乐,许玉玲,黄学勇,等.河南省 2010 年肠道病毒 EV71 型分离株全基因组序列分析[J].郑州大学学报:医学版,2011,46(5):699-703.

[25] Zhang Y,Liu H,Wang L,et al.Comparative study of the cytokine/chemokine response in children with differing disease severity in enterovirus 71-induced hand,foot,and mouth disease [J].PLos One,2013,8(7):e67430.

[26] Li SX,Cai CY,Feng JY,et al.Peripheral T lymphocyte subset imbalances in children with enterovirus 71-induced hand,foot and mouth disease [J].Virus Res,2014,180(4):84-91.

重症手足口病主要危险因素的Meta分析

Main risk factors of severe hand-foot-mouth disease: A Meta-analysis

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