Abstract：
For the past few years, only a few monovalent EV71 vaccines have been developed, while other enterovirus vaccines are in short supply. We conducted a quantitative meta-analysis to explore the epidemiological characteristics, routine laboratory diagnosis, clinical signs and risk factors for hand, foot and mouth disease (HFMD).
PubMed, Embase and the Web of Science were searched for eligible reports published before April 16, 2021, with no publication time or language restrictions. The primary outcome was the odds ratio of the epidemiological characteristics, routine laboratory diagnosis, and clinical signs associated with HFMD severity and death.
After screening 10522 records, we included 32 articles comprising 781903 cases of hand, foot and mouth disease. Patients with severe illness developed some clinical signs (hypersomnia (OR = 21.97, 95% CI: 4.13 to 116.74), convulsion (OR = 16.18, 95% CI: 5.30 to 49.39), limb shaking (OR = 47.96, 95% CI: 15.17 to 151.67), and breathlessness (OR = 7.48, 95% CI: 1.90 to 29.40)) and had some changes in laboratory parameters (interleukin-6 levels standardized mean difference (SMD) = 1.57, 95%CI: 0.55 to 2.60), an increased neutrophils ratio (SMD = 0.55, 95%CI: 0.17 to 0.93), cluster of differentiation 4 (CD4+) (SMD = -1.38, 95%CI: -2.33 to -0.43) and a reduced lymphocytes ratio (SMD = -0.48, 95%CI: -0.93 to -0.33)) compared with patients with mild illness. The risk factors for death included cyanosis (OR = 5.82, 95% CI: 2.29 to 14.81), a fast heart rate (OR = 3.22, 95% CI: 1.65 to 6.30), vomiting (OR = 2.70, 95% CI: 1.33 to 5.49) and an increased WBC count (SMD = 0.60, 95% CI: 0.27 to 0.93).
China has the highest incidence of HFMD. Our meta-analyses revealed important risk factors that are associated with the severity and mortality of HFMD.
PubMed, Embase and the Web of Science were searched for eligible reports published before April 16, 2021, with no publication time or language restrictions. The primary outcome was the odds ratio of the epidemiological characteristics, routine laboratory diagnosis, and clinical signs associated with HFMD severity and death.
After screening 10522 records, we included 32 articles comprising 781903 cases of hand, foot and mouth disease. Patients with severe illness developed some clinical signs (hypersomnia (OR = 21.97, 95% CI: 4.13 to 116.74), convulsion (OR = 16.18, 95% CI: 5.30 to 49.39), limb shaking (OR = 47.96, 95% CI: 15.17 to 151.67), and breathlessness (OR = 7.48, 95% CI: 1.90 to 29.40)) and had some changes in laboratory parameters (interleukin-6 levels standardized mean difference (SMD) = 1.57, 95%CI: 0.55 to 2.60), an increased neutrophils ratio (SMD = 0.55, 95%CI: 0.17 to 0.93), cluster of differentiation 4 (CD4+) (SMD = -1.38, 95%CI: -2.33 to -0.43) and a reduced lymphocytes ratio (SMD = -0.48, 95%CI: -0.93 to -0.33)) compared with patients with mild illness. The risk factors for death included cyanosis (OR = 5.82, 95% CI: 2.29 to 14.81), a fast heart rate (OR = 3.22, 95% CI: 1.65 to 6.30), vomiting (OR = 2.70, 95% CI: 1.33 to 5.49) and an increased WBC count (SMD = 0.60, 95% CI: 0.27 to 0.93).
China has the highest incidence of HFMD. Our meta-analyses revealed important risk factors that are associated with the severity and mortality of HFMD.
摘要：
在过去的几年里,仅开发了几种单价EV71疫苗，而其他肠道病毒疫苗供不应求。我们进行了定量荟萃分析，以探讨流行病学特征，常规实验室诊断，手的临床体征和危险因素，口蹄疫（HFMD）。
PubMed,搜索了Embase和WebofScience在2021年4月16日之前发布的合格报告，没有发布时间或语言限制。主要结果是流行病学特征的比值比，常规实验室诊断，以及与手足口病严重程度和死亡相关的临床体征。
筛选10522条记录后，我们包括32篇文章，包括781903例手案，口蹄疫.患有严重疾病的患者出现了一些临床症状（失眠症（OR=21.97，95％CI：4.13至116.74），惊厥（OR=16.18，95%CI：5.30至49.39），肢体抖动（OR=47.96，95%CI：15.17至151.67），和呼吸困难（OR=7.48，95％CI：1.90至29.40）），并且实验室参数有一些变化（白介素6水平标准化平均差（SMD）=1.57，95CI：0.55至2.60），中性粒细胞比率增加（SMD=0.55，95CI：0.17至0.93），与轻度疾病患者相比，分化簇4（CD4）（SMD=-1.38，95CI：-2.33至-0.43）和淋巴细胞比率降低（SMD=-0.48，95CI：-0.93至-0.33）。死亡的危险因素包括紫癜(OR=5.82,95%CI:2.29~14.81),心率快（OR=3.22，95%CI：1.65至6.30），呕吐（OR=2.70，95％CI：1.33至5.49）和白细胞计数增加（SMD=0.60，95％CI：0.27至0.93）。
中国是手足口病发病率最高的国家。我们的荟萃分析揭示了与手足口病的严重程度和死亡率相关的重要危险因素。
PubMed,搜索了Embase和WebofScience在2021年4月16日之前发布的合格报告，没有发布时间或语言限制。主要结果是流行病学特征的比值比，常规实验室诊断，以及与手足口病严重程度和死亡相关的临床体征。
筛选10522条记录后，我们包括32篇文章，包括781903例手案，口蹄疫.患有严重疾病的患者出现了一些临床症状（失眠症（OR=21.97，95％CI：4.13至116.74），惊厥（OR=16.18，95%CI：5.30至49.39），肢体抖动（OR=47.96，95%CI：15.17至151.67），和呼吸困难（OR=7.48，95％CI：1.90至29.40）），并且实验室参数有一些变化（白介素6水平标准化平均差（SMD）=1.57，95CI：0.55至2.60），中性粒细胞比率增加（SMD=0.55，95CI：0.17至0.93），与轻度疾病患者相比，分化簇4（CD4）（SMD=-1.38，95CI：-2.33至-0.43）和淋巴细胞比率降低（SMD=-0.48，95CI：-0.93至-0.33）。死亡的危险因素包括紫癜(OR=5.82,95%CI:2.29~14.81),心率快（OR=3.22，95%CI：1.65至6.30），呕吐（OR=2.70，95％CI：1.33至5.49）和白细胞计数增加（SMD=0.60，95％CI：0.27至0.93）。
中国是手足口病发病率最高的国家。我们的荟萃分析揭示了与手足口病的严重程度和死亡率相关的重要危险因素。
