本文選題：手足口病 + 流行特征��； 參考：《中國科學(xué)技術(shù)大學(xué)》2017年碩士論文

【摘要】：手足口病作為一種常見兒童傳染病,是如今造成中國兒童死亡的一個重要原因。鑒于該疾病的重要影響,本文將阜陽市手足口病監(jiān)測資料作為樣本,對2009-2013年阜陽地區(qū)手足口病的流行特征及影響因素進(jìn)行了討論,包括重癥危險因素以及該病與氣候因素的關(guān)系。2009-2013年阜陽市一共報告了 95 937例手足口病病例,包括95 417例普通病例和520例重癥病例。本研究首先對手足口病的流行情況進(jìn)行了描述性分析,分析了發(fā)病的時間、地區(qū)、人群、病毒類型、月齡、出生月份和發(fā)病月份分布。研究發(fā)現(xiàn),阜陽地區(qū)手足口病高發(fā)期為4-6月。潁上縣和臨泉縣是手足口病的高發(fā)地區(qū),潁州區(qū)的發(fā)病率最高,太和縣的重癥病例數(shù)最多。報告病例中有63.61%男性患者和36.39%女性患者,平均男女比為1.75:1。散居兒童占報告病例主體(96.8%)。在1 000例實驗室診斷病例中,59%是enterovirus 71(EV 71)感染者,7.2%是coxsackie A16(Cox A16)感染者,33.8%是其他腸道病毒感染者。手足口病發(fā)病與患者年齡有關(guān),以12個月為周期,12,24,36,48,60個月的兒童發(fā)病數(shù)最多。在60個月以下兒童這個群體中,與出生在1月的兒童相比,出生在5月的兒童的患病相對危險度增加8倍以上(relative risk = 8.88,RR)。本研究利用Logistic回歸模型探索重癥手足口病的危險因素。單因素Logistic回歸模型研究表明,患者年齡、居住地區(qū)、出生月份以及發(fā)病前7天平均氣溫、最高氣溫、最低氣溫和氣壓的均值是重癥手足口病的危險因素。多因素Logistic回歸模型表明,相對于居住在臨泉縣,居住在太和縣和潁上縣是危險因素(odds ratio分別為2.68和1.99,OR),而居住在潁州區(qū)則是保護(hù)因素(OR=0.56)。與出生在1月相比,出生在3-12月的病人有2倍以上風(fēng)險發(fā)展成為重癥病例。特別地,與在1月出生相比,在8月出生的患者有5倍多的風(fēng)險成為重癥病人。低齡患者更易發(fā)展成為重癥病例,發(fā)病前7天平均氣溫也是重癥的危險因素(OR=1.02)。本研究利用廣義相加模型研究氣候因素和手足口病發(fā)病數(shù)之間的關(guān)系。在控制了時間的長期趨勢和季節(jié)性之后,我們發(fā)現(xiàn)平均氣溫和相對濕度與每周發(fā)病數(shù)有關(guān)。在線性影響假設(shè)下,氣溫每升高1℃,手足口病發(fā)病的相對危險度增加2.79%;相對濕度每增加1%,發(fā)病相對危險度下降0.32%。在非線性影響假設(shè)下,氣溫大于13℃時、相對濕度高于70%時是手足口病的危險因素。本文的研究結(jié)果可幫助制定手足口病管理措施。例如對高危群體實施定向疫苗接種措施,可提高疫苗接種效率。相關(guān)管理機(jī)構(gòu)也可以根據(jù)研究結(jié)果在適當(dāng)?shù)臅r候發(fā)出預(yù)警,以減少可能發(fā)生的損失。
[Abstract]:Hand, foot and mouth disease (HFMD), as a common infectious disease in children, is an important cause of death in China. In view of the important influence of this disease, the epidemic characteristics and influencing factors of hand, foot and mouth disease in Fuyang from 2009 to 2013 were discussed by using the surveillance data of hand, foot and mouth disease in Fuyang as a sample. 95,937 hand-foot-mouth disease cases were reported in Fuyang city from 2009 to 2013, including 95,417 common cases and 520 severe cases. In this study, the epidemic situation of HFMD was analyzed, and the time, region, population, virus type, age of month, month of birth and month of onset were analyzed. It was found that the high incidence of HFMD in Fuyang area was from April to June. Yingshang County and Linquan County are the high incidence areas of HFMD, Yingzhou District has the highest incidence, Taihe County has the most severe cases. Of the reported cases, 63.61% were male and 36.39% female, with an average male to female ratio of 1.75: 1. Scattered children accounted for 96. 8% of the reported cases. Among the 1 000 laboratory diagnosed cases, 59% were enterovirus 71(EV 71) and 7.2% were coxsackie A16(Cox A16) and 33.8% were other enterovirus infections. The incidence of HFMD was related to the age of the patients. In the group of children under 60 months, the relative risk of disease in children born in May was more than eight times higher than that in children born in January, and the relative risk was more than eight times higher than that in children born in January. In this study, Logistic regression model was used to explore the risk factors of severe hand, foot and mouth disease. Univariate Logistic regression model showed that the mean values of mean air temperature, maximum temperature, minimum temperature and air pressure in patients' age, living area, month of birth and 7 days before onset were risk factors of severe HFMD. The multivariate Logistic regression model showed that compared with living in Linquan County, the odds ratio of living in Taihe County and Yingshang County were 2.68 and 1.99 respectively, while those living in Yingzhou District were the protective factors. Patients born between March and December were more than twice as likely to develop severe cases as they were born in January. In particular, patients born in August were more than five times more at risk of becoming severe than those born in January. Young patients were more likely to develop into severe cases, and the mean temperature 7 days before onset was also a risk factor for severe disease. A generalized additive model was used to study the relationship between climate factors and the incidence of hand, foot and mouth disease (HFMD). After controlling the long-term trend and seasonality of time, we found that the average temperature and relative humidity were related to the number of cases per week. Under the assumption of linear influence, the relative risk of HFMD increased by 2.79 for each temperature rise of 1 鈩，

本文編號：1859783