重症手足口病危险因素分析

Analysis of risk factors of severe hand, foot and mouth disease

目的 探讨重症手足口病（HFMD）的相关危险因素.方法 随机选择重症HFMD患儿175例和同时住该院的轻症HFMD患儿183例,采用单因素分析两组年龄、性别、居住地、症状、体征和实验室检查等资料,筛选出P＜0.05的相关危险因素进行多因素Logistic回归分析,对筛选出的重症HFMD危险因素进行ROC分析.结果 单因素分析显示：呼吸困难、行走不稳、呕吐、肢体抖动、意识障碍、抽搐、出冷汗无力、热程、发热程度、肺部啰音、心率、肠道病毒71型（EV71）血清抗体、循环衰竭、白细胞计数、血小板计数、中性粒细胞比值、CRP、血糖等在轻症患儿和重症患儿差异均有统计学意义（x2=15.236、19.819、33.823、52.670、12.984、10.180、29.318、52.932、34.544、14.615、46.633、31.407和5.303,t值分别为3.184、3.144、2.256、2.244和2.828,均P＜0.05）.多因素Logistic回归分析表明：热程、惊跳震颤或肢体抖动、EV71血清抗体、呕吐、发热程度、中性粒细胞比值为重症HFMD相关危险因素（B值分别为2.605、2.129、1.409、1.185、0.841和0.103,均P＜0.05）.ROC分析显示：预测概率和热程的曲线下面积大于其他危险因素,且有较好的诊断价值[95％ CI分别为（0.888 ～0.961）和（0.818 ～0.920）].结论 3岁以下是HFMD高危人群,出现持续高热、呕吐、惊跳震颤或肢体抖动、EV71血清抗体、中性粒细胞比值升高为重症HFMD的危险因素,预测概率比其他危险因素更有诊断价值.

Objective To investigate the risk factors of severe hand,foot and mouth disease （HFMD）.Methods 175 severe cases of HFMD and 183 mild cases of HFMD in the same period were randomly selected.Single factor analysis was first performed between severe and mild cases on age,gender,residence,symptoms,signs and laboratory examinations,etc,to screen out the related risk factors which P value 〈 0.05.Then,binary logistic regression analysis was carried out to determine risk factors most related to severe HFMD.Finally,receiver operating characteristic curve （ROC） analysis was performed on severe HFMD related risk factors.Results Single factor analysis showed that there were obvious differences between children with mild HFMD and those with severe HFMD in the factors like difficulty in breathing,walking instability,vomiting,limb shaking,disturbance of consciousness,convulsions,cold sweat and weakness,thermal process,the degree of fever,pulmonary rales,heart rate,serum EV71 antibody,circulatory failure,leukocyte count,platelet count,neutrophil ratio,CRP,blood glucose,etc （x2 =15.236,19.819,33.823,52.670,12.984,10.180,29.318,52.932,34.544,14.615,46.633,31.407 and 5.303,t =3.184,3.144,2.256,2.244 and 2.828,,all P 〈0.05）.Binary logistic regression analysis showed that the thermal process,startle tremor or limb jitter,serum EV71 antibody,vomiting,fever,neutrophil ratio were the related risk factors of severe HFMD （B value =2.605,2.129,1.409,1.185,0.841 and 0.103,all P 〈 0.05）.ROC analysis showed that the areas under the curve of the predicted probability and thermal process were larger than any other risk factors [（95% CI （0.888 ～ 0.961） and （0.818 ～ 0.920）],and thus had better diagnostic values.Conclusion Children under 3 years old were the high risk population of HFMD.Such clinical symptoms as persistent high fever,vomiting,startle tremor orlimb jitter,EV71 antibody in serum and increasing neutrophil ratio were risk factors for severe HFMD.The predicted probability had more diagnostic value than any other risk factors.