【摘要】 目的 探讨河北省手足口病与气温之间的关系，分析各城市气温与手足口病暴露反应关系的异质性及其影响因素。方法 通过中国传染病网络报告系统收集2017—2019年河北省11个地级市的手足口病日发病数据，通过中国气象数据网收集各地市同期的气象数据，通过《河北统计年鉴》获得GDP、人均可支配收入、人口密度、每千人医生数等数据。使用R语言（4.1.2版本）软件构建全省及各市分布滞后非线性模型（Distributed Lag non-linear model,DLNM），了解气温对手足口病的滞后效应；对各城市手足口病累积风险曲线进行多变量Meta分析，构建全省累积风险曲线拟合模型，分析河北省气温—手足口病暴露反应关系。采用Meta回归分析，评价各市之间的异质性情况。结果 全省DLNM模型显示，河北省日均气温在-4.5℃滞后5 d时，手足口病的发病风险最低（RR=0.943,95%CI:0.891～0.998）；在31℃滞后0 d时，手足口病的发病风险最高（RR=1.223,95%CI:1.067～1.402）。累积风险曲线显示，河北省手足口病累积发病风险随着温度的升高而升高。高温（P97.5=29.079℃）在滞后0～2 d及滞后4～13 d会增加时手足口病发病风险，滞后0 d时发病风险最高（RR=1.218,95%CI:1.098～1.351）；低温（P2.5=-6.815℃）在滞后4～14 d时会降低手足口病发病风险，滞后14 d时发病风险最低（RR=0.763,95%CI:0.671～0.868）。Meta回归分析显示，纬度可能是各城市间气温与手足口病关系存在异质性的原因（P<0.001）；敏感性分析显示，改变最大滞后时间与自由度后，模型无明显变化。结论 温度对手足口病的发病存在明显的影响并带有一定的滞后性，高温可增加手足口病的发病风险。在高温季节应加强易感人群和高温敏感地区的手足口病预防控制。更多还原

【Abstract】 Objective To analyze the relationship between hand,foot and mouth disease(HFMD) and temperature,and explore the heterogeneity among cities in Hebei Province and influencing factors. Methods The data of the daily number of HFMD cases in 11 prefecture-level cities of Hebei Province from 2017 to 2019 was collected through China Infectious Disease Network Reporting System,the meteorological data for the same period in each city was collected through China Meteorological Data Network,Hebei Statistical Yearbook was used to obtain GDP,disposable income per capita,population density and number of doctors per 1,000 people. Distributed Lag non-linear model(DLNM) was constructed by using R language(version 4.1.2) software to understand the lagged effect of temperature on HFMD in Hebei Province and each city. Multivariate Meta-analysis was performed on the cumulative risk curves of HFMD in each city,and the cumulative risk curves were plotted to analyze the temperature-HFMD exposure response relationship in Hebei Province. Finally,Meta-regression analysis was used to evaluate the heterogeneity among cities. Results The provincial DLNM model showed that the risk of HFMD incidence in Hebei Province was lowest at an daily average temperature of-4.5℃ with a 5-day lag(RR=0.943,95%CI:0.891-0.998) and highest at31℃ with a 0-day lag(RR=1.223,95%CI:1.067-1.402). The cumulative risk curve showed that the cumulative risk of HFMD in Hebei Province increased with the increasing temperature. The high temperature(P97.5=29.079℃) increased the risk of HFMD incidence at lags of 0-2 days and 4-13 days,and the risk was highest at a 0 day lag(RR=1.218,95%CI:1.098-1.351),the low temperature(P2.5=-6.815℃) decreased the risk of HFMD incidence at lags of 4-14 days,and the risk was lowest at a 14-days lag(RR=0.763,95%CI:0.671-0.868). Meta-regression analysis showed that the latitude may be responsible for the heterogeneity among cities(P<0.001). The sensitivity analysis showed that there was no significant change in this model even if aftering the maximum lag time and the degrees of freedom. Conclusion There is a clear influence of temperature on the onset of HFMD,high temperatures can increase the risk of HFMD incidence. Prevention control of HFMD for susceptible populations and heat-sensitive areas should be strengthened during hot season.更多还原