Objective To investigate the risk factors of severe hand, foot and mouth disease (HMFD), so as to provide evidence for predicting disease condition and choosing the reasonable treatment. Methods A total of 116 HFMD patients with complete medical record, who had been admitted, diagnosed and treated systematically in our hospital from Jan. 2008 to Jun. 2013, were enrolled in the study, including 39 patients with severe HFMD (severe group), and 77 patients with ordinary HFMD (ordinary group). Twenty-one potential factors associated with the occurrence of severe HFMD were evaluated by univariate and multivariate logistic regression analysis. Results As compared with the ordinary group, the children of the severe group were younger, mainly chose community hospital or individual clinic for their first visit, had shorter interval from HFMD onset to the first visit, and were more likely to suffer from respiratory disease one month before HFMD onset (P<0.05); the severe group had a higher proportion of patients with fever (more severe condition and longer duration), a more frequent occurrence of vomiting, less occurrence of hand rash, mouth ulcers or herpes, but greater likelihood of the occurrence of neurological symptoms such as drowsiness and hand or leg trembling (P<0.05); the severe group had greater number of patients with higher blood sugar and WBC count of >10.8 ×109/L, and suffering from enterovirus (EV) 71 infection (P<0.05). The factors including sex, premature birth, low birth weight, cough, foot rash and the percentage of neu-trophils were not significantly different between the severe group and the ordinary group (P>0.05). Multivariate logistic regression analysis showed that the independent risk factors of severe HFMD included the age of <1 year old, the interval from HFMD onset to the first visit≤1 day, WBC count of>10.8×109/L, vomiting and EV71 infection (OR:1.982, 2.296, 2.359, 5.553 and 13.127, respectively, P<0.05). Conclusions The occurrence of severe HFMD is correlated with many factors, and it is suggested that efforts should be made in screening various risk factors strictly, and predicting the disease condition early.%目的：探讨重症手足口病（hand, foot and mouth disease, HFMD）发生的危险因素，为提前预判病情并选择合适的治疗方案提供思路。方法收集2008年1月-2013年6月我院收治、确诊、系统治疗且有完整病案记录的HFMD患儿116例，其中重症HFMD 39例（重症组），普通HFMD 77例（普通组）。对21项可能与普通HFMD发展为重症HFMD的有关因素进行单因素和多因素logistic回归分析。结果与普通组相比，重症组年龄更小，首次就诊医院类型以社区/个人诊所为主，发病至首次就诊时间间隔更短，发病前1个月内有呼吸道病史的病例更多；重症组发热比例更大，发热程度更重，热程更长，呕吐发生更频繁，而手部疹、口腔溃疡或疱疹较少，更易出现神经症状如嗜睡及手足抖动；重症组血糖更高、外周血WBC计数＞10.8×109/L及感染肠道病毒71型（enterovirus 71, EV71）例数更多（P＜0.05）。而性别、是否早产、是否为低体重儿、咳嗽、足部疹和中性粒细胞百分比比较差异无统计学意义（P＞0.05）。进一步多因素logistic回归分析显示，影响重症HFMD发生的独立危险因素包括年龄＜1岁、发病至首次就诊时间间隔≤1 d、WBC计数＞10.8×109/L、呕吐、感染病毒为EV71（OR分别为1.982、2.296、2.359、5.553、13.127，P均＜0.05）。结论重症HFMD的发生与多因素有关，建议严格筛查各危险因素并提早对病情进行预判。
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