648例手足口病回顾性分析

Logistic regression analysis of 648 patients with hand foot and mouth disease

目的:探讨重症手足口病的危险因素。方法:对2008年4月～2009年6月留观和住院的手足口病患儿的临床表现进行回顾性分析。结果:对全部被调查者的11个项目进行单因素相关分析,其中8项有显著性(P<0.05),分别是精神差、惊跳、嗜睡、发热天数≥3天、热峰≥38.5℃、呕吐、头痛、皮疹分布(无口腔溃疡)。热程≥3天的灵敏度、特异性、阳性预测值、阴性预测值分别为:61.8%,80.2%,58.9%,82.0%;热峰≥38.5℃的灵敏度、特异性、阳性预测值、阴性预测值分别为:39.8%,88.4%,91.6%,31.6%;惊跳的灵敏度、特异性、阳性预测值、阴性预测值分别为:72.7%,80.2%,96.6%,90.3%;呕吐的灵敏度、特异性、阳性预测值、阴性预测值分别为:82.6%,76.4%,40.2%,95.8%;精神的灵敏度、特异性、阳性预测值、阴性预测值分别为:67.4%,90.2%,82.2%,80.4%。精神差是中枢神经系统感染的独立危险因素。结论:精神差、惊跳、嗜睡、发热天数≥3天、热峰≥38.5℃、呕吐、头痛、皮疹分布(无口腔溃疡)为手足口病的危险症状,确定这些危险症状,有助于早期识别重症病例,早期治疗,降低死亡率。

Objective：To investigate the risk factors of hand foot and mouth disease（HFMD）.Methods：Data collected through a prospective clinical study of HFMD conducted between 2008 and 2009 were examined to identify risk factors associated with neurological involvement in children with HFMD.Results：There were significantly differencs in listlessness,start,history of lethargy,total duration of fever≥3 days,peak temperature ≥38.5℃,vomit,headache,and absence of mouth ulcers.Listlessness was identified as an independent risk factor for neurological involvement in the analysis of 648 children admitted to hospital.Total duration of fever ≥3 days,peak temperature≥38.5℃,start,vomit,and listlessness had the sensitivity,specificity,positive predictive value（PPV） and negative predictive value（NPV） respectively：61.8%,80.2%,58.9%,82.0%;39.8%,88.4%,91.6%,31.6%;72.7%,80.2%,96.6%,90.3%;82.6%,76.4%,40.2%,95.8%;67.4%,90.2%,82.2%,80.4%.Conclusion：Listlessness,start,history of lethargy,total duration of fever ≥3 days,peak temperature≥38.5℃,vomit,headache,and absence of mouth ulcers were identified as clinical risk factors to help detect children at risk of neurological involvement.These risk factors may serve as a guide to clinicians to decide the need for hospitalization, further investigation,close monitoring for disease progression,and decrease of mortality in children with HFMD.