重症手足口病病例并发神经源性肺水肿高危因素的配比病例对照研究

Comparison study of matching cases on high risk factors of the development from severe hand-foot-and-mouth disease to neurogenic pulmonary edema

目的研究重症手足口病(hand-foot-and-mouth disease,HFMD)进展为神经源性肺水肿的高危因素,为神经源性肺水肿的早期诊断及干预提供依据。方法选择2010年4月1日至2010年10月30日在石家庄市第五医院就诊的重症手足口病患者,根据是否进展为神经源性肺水肿而进行分组,选择性别和年龄作为配比因素进行1∶3的配比病例对照研究。结果两组患儿在发病-就诊时间、发病-重症时间、初诊在村级医疗机构就诊、初诊确诊手足口病、最高体温≥39℃、持续高热(体温≥38.5℃且持续时间≥3d)、肢体无力、呼吸浅快或节律不规则、肺部杂音、血压≥130mm Hg、心率≥150次/min和血氧饱和度≤91%以及外周白细胞计数>12×109/L、血糖>8.3mmol/L、肌酸激酶升高、C反应蛋白阳性的发生率等因素差异均具有显著性(P<0.05),而首发症状、皮疹类型、抽搐、呕吐、肝功能异常等方面的差异无显著性(P>0.05)。结论多因素logistic回归分析表明,持续高热、肢体无力、心率≥150次/min和血糖>8.3mmol/L共同构成了重症手足口病进展为神经源性肺水肿的高危因素,而初诊确诊手足口病则为保护性因素。

Objective To study the high risk factors which are relative to the development of severe hand-foot-and-mouth disease（HFMD） to neurogenic pulmonary edema.Method Choose severe HFMD patients in Shijiazhuang No.5 hospital from Apr.1 to Oct.30 in 2010 and divid them into groups according to whether develop into neurogenic pulmonary edema.Conduct 1 to 3 matched cases-control study by choosing sex and age as matched factor.Results The two groups of patients all showed significance（P0.05）in factors of disease-diagnosis time,disease-severe time,the first diagnosis at village-level medical institutions and confirmed HFMD,the highest temperature≥39℃,long-term high fever（temperature≥38.5℃ and lasting for≥3days）,weakness of limbs,tachypnea or arrhythmias,lungs souffle,blood pressure≥130mm Hg,heart rate≥150time/min,oxygen saturation of blood ≤ 91%,number of peripheral white blood cells12×109/L,blood sugar8.3mmol/L,the rise of creatine kinase and the incidence rate of C reactive protein test positive.But there were no significant differences（P0.05）in aspects of First symptoms,type of tetter,convulsion,vomiting and liver dysfunction.Conclusions Multi-factor logistic regression analysis showed us that long-term high fever,weakness of limbs,heart rate ≥ 150time/min and blood sugar8.3mmol/L constitute the high risk factors of Severe HFMD developing to Neurogenic Pulmonary Edema,and confirmed HFMD at the first diagnosis is a protective factor.