EV-71感染手足口病早期临床表现对中枢神经系统并发症的预测

Prediction of Early Clinical Manifestations of Hand,Foot and Mouth Disease Caused by EV-71 on Central Nervous System Complications

目的验证EV-71感染手足口病早期临床表现中发热≥3 d,热峰≥38.5℃、易惊这3个危险因素对中枢神经系统并发症的预测作用。方法收集2014年5月至2014年8月间在发热门诊就诊的手足口病患儿,以脑脊液细胞计数升高为诊断合并中枢神经系统损害的金标准,验证这3个危险因素的预测作用。结果 CNS组患儿中含≥2个危险因素的有69例(73%),NOR组只有35例(66%),差异有统计学意义(χ2=5.698,P=0.015);发热1 d和2 d患儿中,热峰≥38.5℃和易惊预测的敏感性、特异性、阳性预测值和阴性预测值分别为:53%、60%、55%和58%;热程≥3 d患儿中分别68%、32%、68%和32%。结论随着危险因素的增加,敏感性增加,漏诊机会减少,阳性预测值增加,证明了3个危险因素在预测中枢神经系统损害中的作用,同时也证实了随着危险因素的增加,合并中枢神经系统损害的可能性越大。

Objective To confirm the predictive effect on central nervous system complications of the 3 risk factors （ fever for ≥3 days, thermal spike ≥38.5 ℃, and hyperaronsal） among the early clinical manifestations of hand, foot and mouth disease （HFMD） caused by EV -71. Methods Children with HFMD visiting our fever clinic from May 2014 to August 2014 were collected, combined with central nervous system damage diagnosed with the increase of cerebrospinal fluid cell count, to confirm the prediction of the risk factors. Results There were 69 cases with 2 or more of the risk factors in the CNS group （73 % ） , and 35 cases in the NOR group （66%）, with statistically significant difference （X^2 =5. 698, P =0. 015）. Among the children with fever for 1 or 2 days, the sensitivity, specificity, positive predictive value （PPV） and negative predictive value （NPV） of the 2 risk factors, thermal spike ≥ 38.5 ℃ and hyperarousal, were 53% , 60% , 55% and 58% , respectively, and among those who had fever for 3 or more days, the four indexes presented to be 68% , 32% , 68% and 32%. Conclusion The increasing risk factors, sensitivity and positive predic- tive value and the decreasing chance of misdiaguosis show the effectiveness of the 3 risk factors in predicting central nervous system damage. It also proves that the possibility of combined central nervous system damage grows greater with the increase of the 3 factors.