Objective To explore the factors associated with severe hand-food-mouth disease (HFMD) case in Shanghai.Methods A total of 105 severe HFMD cases diagnosed from May to July,2011 in Shanghai were enrolled as case group while another 210 mild HFMD cases were randomly selected as control group in the same period.All subject' s parents or babysitters were asked to fill in the questionnaire in which including demography,ways of babysitting,behavior and the like.All HFMD cases were diagnosed by both clinical symptom and nuclear acid testing.Data was processed by EpiData (V3.0) and analyzed by SPSS (V17.0).Results Factors as age,gender,Diaspora pattern,migrant,size of house,numbers of family member,numbers of children,frequency of seeing doctor,dishware that sharing with babysitter,food chewed by babysitter,dirty hand,EV71 virus type and diagnosis on HFMD in the fist visit to hospital were found associated with severe HFMD by univariate analysis.Results through multivariate logistic regression showed that factors including:being the only male kid,more than 3 children in the family,dirty hands,unable to be diagnosed as HFMD in the first visit to the hospital,visiting doctor during the past 6 months for 2 and 3 times etc.could be kept in the model with statistical threshold of 0.05.Adjusted ORs and confidence intervals of them were 2.431 ( 1.317-4.487),2.661 (1.332-5.315),3.403 ( 1.871-6.191 ),6.607 (3.011-14.500),2.431 ( 1.111-5.321 ),2.628 ( 1.137-6.071 ) respectively.Being Infected by EV71 was also found a very important risk factor compared with CoxA16 or other enteroviruses,and its adjusted OR was 5.614 (2.409-13.082).Conclusion It was necessary to implement molecular diagnosis for identifying the virus type of HFMD,together with improvement on the capacity of clinical diagnosis in order to diagnose the HFMD cases earlier.More attention should be paid to these HFMD cases with EV71 infection as well as prompting frequent visits to hospitals on those families with more children.%目的 探讨上海市儿童手足口病重症病例的影响因素.方法 收集2011年5-7月上海市105例重症手足口病和210例轻症手足口病的临床诊断病例,进行非匹配的病例对照研究,采用统一调查表进行调查,资料应用EpiData 3.0软件建立数据库,使用SPSS 17.0软件进行单因素和多因素非条件logistic回归分析.结果 单因素分析显示,年龄、性别、看护方式、居住方式、家庭人口数、家庭儿童数、就医次数、共用餐具、咀嚼喂食、手部清洁程度、病原体类型、初诊是否为手足口病等为重症病例的影响因素；多因素分析显示男性(OR=2.431,95％CI:1.317～4.487)、家庭儿童数≥3人(OR=2.661,95％CI:1.332 ～ 5.315)、患儿手部不清洁(OR=3.403,95％CI:1.871 ～ 6.191)、初诊未诊断为手足口病(OR=6.607,95％CI:3.011 ～ 14.500)、半年内就医2次(OR=2.431,95％CI:1.111 ～ 5.321)和≥3次(OR=2.628,95％CI:1.137～6.071)为重症病例的危险因素.病原学结果显示,EV71型引起的重症病例是柯萨奇病毒A16型及其他肠道病毒的5.614倍(95 ％CI:2.409 ～ 13.082).结论 为防范发生重症手足口病,应提高医疗机构的早期诊断能力,并开展病原的分子检测,重视儿童手部卫生并加强身体素质锻炼,同时对男性、多儿童家庭和EV71感染患儿给予密切关注.
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