Abstract: Background　Hand-foot-mouth disease（HFMD） is a global infectious disease caused by more than 20 kinds of enterovirus infections.Since 2008，HFMD has been a high-incidence acute infectious disease in China，with a high prevalence of severe cases，endangering children's health.Objective　To study the clinical characteristics and influencing factors of hospitalized pediatric HFMD cases using the data of a large clinical sample collected from Yunnan Province during 2008 to 2017.Methods　A retrospective design was used.Data of HFMD children with hospitalization experience during 2008 to 2017 were collected through the electronic medical record system of Kunming Children's Hospital，including number of cases，onset time，age，gender，clinical classification and staging of HFMD，and were analyzed using statistical methods.Results　（1）A total of 11 510 HFMD cases were hospitalized in this hospital during this 10-year period.The disease was prevalent throughout the year，and showed a single peak pattern，with a peak period from April to August.（2）Boys outnumbered girls，with a male to female ratio of 1.13:1.The children had an average age-of-onset of（2.37±1.50） years，but showed an uneven age-of-onset distribution，the youngest was 37 days，and the oldest was 14 years old，and those under 3 years had the highest incidence rate，accounting for the largest percentage of the total〔86.72%（9 982/11 510）〕.There were 3 368 common cases（29.26%），and 8 142 severe cases （70.74%）.Of the severe cases，intermediate-to-severe and critical cases accounted for 40.75%（4 690/8 142），and 29.99%（3 452/8 142），respectively，and the percentage of cases aged less than 3 years accounted for 88.02%.The incidence of severe and critical HFMD differed significantly across all age groups（P<0.05）.（3）In the early stage of critical HFMD，the prevalence of hypertension，increased heart rate，accelerated respiration，poor blood circulation in tips of fingers and toes，limb paralysis，and urinary retention was 100.00%（3 452/3 452），94.84%（3 273/3 452），86.44%（2 983/3 452），69.76%（2 408/3 452），1.83%（63/3 452），and 0.41%（14/3 452），respectively.（4）The examination of stool samples from 88.91%（10 234/11 510） of the cases revealed the presence of EV71 in 3 843 cases（33.39%），COA16 in 1 112 cases（9.66%），and other enteropathogens in 3 560 cases（30.93%）.The main pathogens were EV71 and COA16 in 2008—2013，and were EV71 and other enteroviruses in 2014—2017.EV71 was the major pathogen for critical HFMD.Conclusion　The hospitalized children with HFMD and severe cases were mainly under 3 years old.EV71 was the main pathogen causing severe HFMD.Hypertension，increased heart rate，accelerated respiration，and poor circulation in tips of fingers and toes may be the early signals of critical HFMD，which should be controlled and treated.actively.

Key words: Hand-foot-mouth disease, Hospitalized children, Clinical characteristics, Etiology, Root cause analysis

摘要： 背景　手足口病是20多种肠道病毒感染引起的全球性传染病。自2008年以来，手足口病在我国发病率高，重症病例占比高，是危害我国儿童健康的急性传染病。目的　探讨 2008—2017年住院手足口病患儿的临床特征，提供云南省内大样本手足口病的临床数据。方法　采用回顾性研究的方法通过电子病案系统收集2008—2017年在昆明市儿童医院住院的手足口病患儿的发病数、发病时间、年龄、性别、临床分型、分期等临床资料进行统计分析。结果　（1）昆明地区10年间住院手足口病患儿共11 510例，全年均有流行，呈单峰型，4—8月是发病高峰期。（2）住院患儿中男孩多于女孩，男女比例为1.13∶1，最小年龄为37 d，最大年龄为14岁6个月，平均年龄（2.37±1.50）岁；在不同年龄段均可发病，住院患儿中3岁及以下儿童发病率最高，共有9 982例（86.72%）；普通型病例3 368例（29.26%），重症病例8 142例（70.74%），重症病例中重型4 690例（40.75%），危重型3 452例（29.99%），3岁及以下儿童重症发生率为88.02%；不同年龄组手足口病在重型及危重型中的发生率差异有统计学意义（P<0.05）。（3）危重型手足口病早期均有高血压3 452例（100%），心率快3 273例（94.84%），呼吸增快2 983例（86.44%），指趾端循环不良2 408例（69.76%），肢体瘫痪63例（1.83%），尿潴留14例（0.41%）。（4）粪便病原学检查10 234例（88.91%），其中肠道病毒71（EV71）有3 843例（33.39%），柯萨奇病毒A组16型（COA16）有1 112例（9.66%），其他肠道病毒有3 560例（30.93%）；2008—2013年病原主要以EV71和COA16感染为主，2014—2017年以其他类型肠道病毒和EV71感染为主，危重型手足口病的病原以EV71感染为主。结论　住院手足口病患儿及重症人群主要是3岁及以下儿童，引起重症手足口病仍以EV71感染为主。高血压、心率快、呼吸增快、指趾端循环不良等是危重手足口病的早期信号，应积极给予救治和控制病情。

关键词: 手足口病, 住院患儿, 临床特征, 病原学, 影响因素分析