重症手足口病患者并发神经源性肺水肿的影响因素分析

Influencing factors of neurogenic pulmonary edema in patients with severe hand-foot-mouth disease

目的:分析重症手足口病(HFMD)患者并发神经源性肺水肿(NPE)的影响因素。方法:选取2014年1月-2019年1月本院收治的101例重症HFMD患儿,根据是否并发NPE分为并发NPE组(50例)、未并发NPE组(51例)。收集两组患儿一般资料,记录两组患儿入院时的症状、体征、血压、血糖、白细胞计数(WBC)、C反应蛋白(CRP)、cTnI、病原学检测结果,应用单因素分析和Logistic多元回归分析影响重症HFMD并发NPE的因素,ROC曲线分析WBC及cTnI对HFMD并发NPE的预测价值。结果:单因素分析结果显示,两组患儿在EV71感染(χ^2=7.50,P=0.006)、最高体温超过39℃(χ^2=11.25,P=0.001)、肢体麻痹(χ^2=12.20,P=0.001)、心动过速(χ^2=22.12,P<0.01)、血压升高(χ^2=19.47,P<0.01)、血糖水平(t=5.93,P<0.01)、WBC水平(t=6.35,P<0.01)、CRP水平(t=5.21,P<0.01)、cTnI水平(t=8.52,P<0.01)方面有明显差异;多因素Logistic回归分析结果显示,心动过速(OR=6.74,P=0.015)、血压上升(OR=4.40,P=0.049)、血糖升高(OR=12.09,P=0.039)、WBC升高(OR=14.15,P=0.032)、cTnI升高(OR=12.23,P=0.043)是并发NPE的独立危险因素。WBC及cTnI预测重症HFMD并发NPE的AUC值分别为0.80、0.89,cTnI的AUC值明显高于WBC的AUC值(P<0.05)。结论:心动过速、血压上升、血糖升高、WBC升高、cTnI升高是HFMD并NPE发生的高危因素,检测cTnI对于预测HFMD并发NPE具有积极意义。

Objective:To explore the influencing factors of neurogenic pulmonary edema(NPE) in patients with severe hand-foot-mouth disease(HFMD). Methods: A total of 101 children with severe HFMD admitted to the hospital from January 2014 to January 2019 were enrolled. According to presence or absence of NPE, these patients were divided into the NPE group(50 cases) and the non-NPE group(51 cases). The demographic characteristics in both groups were collected. The symptoms, signs, blood pressure, blood glucose, white blood cell count(WBC), C-reactive protein(CRP), cTnI ad etiological test results at admission in both groups were recorded. The influencing factors of NPE in patients with severe HFMD were analyzed by univariate and Logistic multivariate regression analysis. The predictive value of WBC and cTnI in HFMD complicated with NPE was analyzed by ROC curves. Results: The results of univariate analysis showed that there were significant differences between the two groups in EV71 infection(χ^2=7.50,P=0.006), maximum temperature over 39°C(χ^2=11.25,P=0.001), limbs paralysis(χ^2=12.20,P=0.001), tachycardia(χ^2=22.12,P<0.01), increased blood pressure(χ^2=19.47,P<0.01), levels of blood glucose(t=5.93,P<0.01), WBC(t=6.35,P<0.01), CRP(t=5.21,P<0.01) and cTnI(t=8.52,P<0.01). The results of multivariate Logistic regression analysis showed that tachycardia(OR=6.74,P=0.015), increased blood pressure(OR=4.40,P=0.049), increased blood glucose(OR=12.09,P=0.039), WBC(OR=14.15,P=0.032) and cTnI(OR=12.23,P=0.043) were independent risk factors of NPE. AUC values of WBC and cTnI for predicting severe HFMD complicated with NPE were 0.80 and 0.89, respectively. AUC of cTnI was significantly higher than that of WBC(P<0.05). Conclusion: Tachycardia, increased blood pressure, increased blood glucose, WBC and cTnI are high-risk factors of HFMD complicated with NPE. cTnI is an important risk factor for predicting HFMD complicated with NPE.