探讨广西壮族自治区妇幼保健院收治手足口病(HFMD)患儿的临床特点。

选择2013年1月1日至2016年12月31日，于广西壮族自治区妇幼保健院就诊的45 793例HFMD患儿为研究对象。在知情同意情况下，采集其中363例普通型HFMD患儿的咽拭子或(和)疱疹液，以及732例重症HFMD患儿的咽拭子标本，进行肠道病毒(EV)71、柯萨奇病毒(Cox)A16和其他EV检测。回顾性分析患儿病例资料，统计学分析本院2013—2016年HFMD如下特点。①每年HFMD重症率及病死率；②HFMD月份、年龄、性别、人群、地区分布特点，以及与这些因素相关的HFMD重症率情况；③HFMD病原学特点。本研究遵循的程序符合广西壮族自治区妇幼保健院伦理委员会制定的伦理学标准，得到该伦理委员会批准。

①45 793例HFMD患儿中，普通型HFMD占98.40%(45 061/45 793)，重症HFMD占1.60%(732/45 793)，重症HFMD患儿的病死率为1.64%(12/732)。其中，2013年的HFMD重症率1.13%为最低，分别与2014年的1.85%、2015年的1.69%及2016年的1.65%比较，差异均有统计学意义(P<0.05)；2014年HFMD病死率为0.06%，分别较2013年的0.01%和2015年的0高，并且差异均有统计学意义(P<0.05)。②2013年及2015年HFMD发病月份分布构成比中，均为9月所占比重最大，分别为30.90%及26.43%，而2014年及2016年则为5月所占比重最大，分别为28.59%及31.47%；2013年4月HFMD重症率为2.15%，2014年2月为5.34%，2015年3月为6.48%，2016年10月为5.50%，分别为当年每月HFMD重症率的最高值。③本研究HFMD患儿年龄分布以>1～3岁所占比重最大(57.47%)，≤5岁患儿所占比重达94.96%；≤1岁患儿及>1～3岁患儿的HFMD重症率，均分别较>3～5岁及>5岁高，并且差异均有统计学意义(P<0.05)。④本研究HFMD患儿中，男性患儿占61.47%(28 149/45 793)，男性患儿HFMD重症率为1.80%(508/28 149)，较女性患儿1.27%(224/17 644)高，并且差异有统计学意义(χ²＝19.745，P<0.001)；散居儿童、幼托儿童及学生的HFMD所占比重分别为73.11%、25.56%及1.33%，其HFMD重症率分别为1.92%、0.67%及1.97%；南宁市城区、南宁市其他县份及南宁市以外地区HFMD分布构成比分别为91.48%、8.31%及0.21%，其HFMD重症率分别为1.09%、7.25%及1.03%。⑤本研究普通型HFMD的EV阳性率为87.05%(316/363)，较重症HFMD为78.28%(573/732)高，并且差异有统计学意义(χ²＝12.272，P<0.001)；本院2013、2014、2015及2016年，普通型HFMD分别以CoxA16、EV71、其他EV及CoxA16感染为主，而重症HFMD分别以其他EV、EV71、其他EV及其他EV感染为主；12例死亡病例中，EV71阳性率为83.34%(10/12)。

本院2013—2016年，HFMD以4～6月或8～10月高发，男性患儿多于女性，主要发生在南宁市城区≤5岁散居儿童。普通型HFMD以CoxA16感染为主，重症HFMD以其他EV感染为主。

To study the clinical characteristics of children with hand, foot and mouth disease (HFMD) in Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region.

A total of 45 793 children with HFMD in Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region from January 1, 2013 to December 31, 2016, were selected as research subjects. After obtaining informed consents of all cases, throat swabs or (and) herpes fluid samples were collected from 363 mild type of HFMD cases, and throat swabs samples from 732 severe type of HFMD cases to detect enterovirus (EV) including EV71, coxsackievirus (Cox)A16 and other types of EV. Clinical data of all children with HFMD were analyzed retrospectively, and the characteristics of HFMD cases in our hospital from 2013 to 2016 were analyzed statistically including: ①rates of severe type and fatality rates of HFMD in each year; ②distribution characteristics of HFMD including months, ages, gender, crowd and region, and rates of severe type of HFMD of these factors; ③etiologic characteristics of HFMD cases. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Maternal & Child Health Hospital of Guangxi Zhuang Autonomous Region.

①Among 45 793 HFMD children, 98.40% (45 061/45 793) of them were with mild type of HFMD, and 1.60%(732/45 793) were with severe type of HFMD. Fatality rate of children with severe type of HFMD was 1.64%(12/732). In 2013, rate of severe type of HFMD (1.13%) was the lowest compared to that of 2014 (1.85%), 2015 (1.69%) and 2016 (1.65%), respectively, and all the differences were statistically significant (P<0.05). Fatality rate of children with HFMD in 2014 (0.06%) was higher than that of 2013 (0.01%) and 2015 (0), respectively, and all the differences were statistically significant (P<0.05). ②Constituent ratio of HFMD monthly incidence: the most cases occurred in September in 2013 and 2015 with proportion of 30.90% and 26.43%, respectively, while the most cases occurred in May in 2014 and 2016 with proportion of 28.59% and 31.47%, respectively. The highest rate of severe type of HFMD every month in each year were 2.15% in April 2013, 5.34% in February 2014, 6.48% in March 2015 and 5.50% in October 2016, respectively. ③For age distribution characteristics: the largest proportion was 57.47% in age of children >1-3 years old. 94.96% of HFMD cases were age of children ≤5 years old.Rates of severe type of HFMD in children ≤1 year old or >1-3 years old were higher than those of children >3-5 years old and >5 years old, respectively, and all the differences were statistically significant (P<0.05). ④The proportion of male children with HFMD was 61.47% (28 149/45 793). Rate of male with severe type of HFMD (1.80%, 508/28 149) was higher than that of female (1.27%, 224/17 644), and the difference was statistically significant (χ²=19.745, P<0.001). HFMD proportion of scattered children, children in kindergarten and students were 73.11%, 25.56% and 1.33%, respectively, and rates of severe type of HFMD were 1.92%, 0.67% and 1.97%, respectively. HFMD constituent ratio of living in Nanning city, other counties in Nanning and other districts outside Nanning were 91.48%, 8.31% and 0.21%, respectively, and rates of severe type of HFMD children were 1.09%, 7.25% and 1.03%, respectively. ⑤EV positive rate of mild type of HFMD cases (87.05%, 316/363) was higher than that of severe type of HFMD cases (78.28%, 573/732), and the difference was statistically significant (χ²=12.272, P<0.001). The preponderant EV from mild type of HFMD cases were CoxA16 in 2013, EV71 in 2017, other types of EV in 2015 and CoxA16 in 2016, and the preponderant EV from severe type of HFMD cases were other types of EV in 2013, EV71 in 2014, other types of EV in 2015 and other types of EV in 2016. There were 12 death cases, and 83.34% (10/12) of them were tested positive of EV71.

From 2013 to 2016 in our hospital, the most HFMD cases occurred annually from April to June, or from August to October, boys were more affected of HFMD than that of girls, and high risk populations were in scattered children≤ 5 years old in Nanning city. The mild type of HFMD cases were mainly caused by Cox A16, and the severe type of HFMD cases were mainly caused by other types of EV.