手足口病患者肾上腺皮质激素应用的影响因素及其与重症病例的关系研究

Influence Factors of Glucocorticoid Treatment in Hand- foot- mouth Disease and Its Relationship with Neurological Complication

目的本研究探讨肾上腺皮质激素在手足口病患者中的使用情况及其影响因素。方法回顾性研究河北大学附属医院290例手足口病患者肾上腺皮质激素应用情况,按照是否应用肾上腺皮质激素分为未用激素组和应用激素组,运用多元Logistic回归分析方法分析手足口病患者肾上腺皮质激素应用的影响因素以及手足口病患者进展为重症病例的危险因素。结果单因素分析显示应用激素组中出现中枢神经系统并发症病例较未用激素组显著升高,多元Logistic回归分析显示,易惊、精神差、发热时间>3天是手足口病患者应用肾上腺皮质激素的影响因素;出现病理征、易惊、精神差以及发热时间>3天是手足口病进展为重症病例的危险因素。结论肾上腺皮质激素的应用与手足口病重症病例的发生相关;临床实践中如出现易惊、精神差、发热时间长等临床表现应及时治疗,慎重应用肾上腺皮质激素,避免病情进展。

Objective To investigate the use of glucocorticoid in the patients with hand-foot-mouth disease（HFMD） and its influence factors. Methods In this retrospective study, 290 hospitalized cases of HFMD were divided into regular treatment group and glucocorticoid treatment group who were admitted methylprednisolone 1-2mg/（kgd）. Patients of both groups accepted antiviral treatment, supportive therapy and intracranial pressure controlling treatment. Multivariate logistic regression analysis was applied to study the influencing factors of glucocorticoid in the treatment of HFMD and the risk factors in HFMD patients with neurological complication. Results There were more patients with neurological complication in the glucocorticoid treatment group than in the regular treatment group （P〈0.05）. Multivariate Logistic regression analysis showed that easily frightened, poor spirit, fever over 3 days were influence factors for glucocorticoid treatment. The analysis also showed that positive pathological signs, easily frightened, poor spirit and fever over 3 days were risk factors for neurological complication caused by HFMD. Conclusion Application of glucocorticoid in HFMD treatment is related to neurological complication caused by HFMD. Easily frightened, poor spirit and over 3 days fever might predict the neurological complication. So more attention should be paid on these factors and a timely treatment should be applied to prevent it from getting worse.