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目的探讨云南省手足口病高发病地区重症病例发生的影响因素,建立预测模型,为制定防控措施提供科学依据。方法采用自行设计的调查表开展调查,收集云南省手足口病发病数前四的州(市)(昆明市、红河州、玉溪市、曲靖市)2009-2013年的病例资料共788例,其中重症病例346例(43.90%),轻症病例442例(56.09%),运用非条件Logistic回归分析方法研究手足口病重症病例的影响因素,并建立回归模型。结果多因素非条件Logistic回归结果显示,发病前与其玩耍的孩子发病(OR=4.705)、初诊在村(个体)诊所(OR=1.753)、发热持续3 d以上(OR=1.155)、住院治疗(OR=4.100)、发高热(OR=2.980)为重症手足口病发生的危险因素;CoxA16阳性(OR=0.503)、自然分娩(OR=0.471)、看护人文化程度为高中以上(OR=0.382)是重症手足口病发生的保护因素。根据结果建立预测模型,模型的灵敏度为91.04%,特异度为85.97%,准确率为64.09%。结论重症手足口病的模型可定量评估重症手足口病发生的概率。
Objective To explore the influencing factors of occurrence of severe cases of HFMD in Yunnan Province and to establish a prediction model to provide a scientific basis for the development of prevention and control measures. Methods A self-designed questionnaire was used to investigate and collect a total of 788 cases from 2009 to 2013 in Kunming, Honghe Prefecture, Yuxi City and Qujing City with the highest incidence of HFMD in Yunnan Province. Among them, 346 cases (43.90%) were severe cases and 442 cases (56.09%) were mild cases. The influencing factors of HFMD cases were studied by non-conditional Logistic regression analysis and regression model was established. Results The results of multivariate non-conditional logistic regression showed that the incidence of pre-morbid children and their children (OR = 4.705) was higher than that of the children (OR = 1.705) (OR = 4.100), high fever (OR = 2.980) was the risk factor for severe HFMD; CoxA16 positive (OR = 0.503), spontaneous childbirth (OR = 0.471) It is a protective factor of severe HFMD. According to the results, a prediction model was established. The sensitivity of the model was 91.04%, the specificity was 85.97% and the accuracy was 64.09%. Conclusion The model of severe hand-foot-and-mouth disease can quantitatively assess the probability of severe hand-foot-and-mouth disease.