重症手足口病患儿危险因素分析

王瑾; 彭万胜; 周瑞; 王亚明; 徐家丽

doi:10.16766/j.cnki.issn.1674-4152.001719

重症手足口病患儿危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.001719

王瑾^{1, 2},
彭万胜²,
周瑞²,
王亚明²,
徐家丽^2, ,

1.
蚌埠医学院研究生院，安徽蚌埠 233003
2.
蚌埠医学院第一附属医院儿科，安徽蚌埠 233004

基金项目:

安徽省卫计委全科医学项目 2016QK092

蚌埠医学院2019年研究生创新项目 Byycx1974

详细信息

通讯作者:
徐家丽，E-mail：641323748@qq.com

中图分类号: R512.5 R725.6
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- 文章访问数: 189
- HTML全文浏览量: 83
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2020-05-28
- 网络出版日期: 2022-02-19

Analysis of risk factors of children with severe hand-foot-mouth disease

1.
Graduate School of Bengbu Medical College, Bengbu, Anhui 233003, China

摘要

摘要: 目的观察重症手足口病(HFMD)患儿的主要实验室检测结果，寻找重症HFMD的危险因素并建立预测模型，为早期诊断、及时治疗提供帮助。方法选取2019年1—12月蚌埠医学院第一附属医院收治的HFMD患儿(包括临床诊断病例和确诊病例)为研究对象，分析临床症状、体征及主要的实验室指标，差异有统计学意义项进行多因素logistic回归分析，构建回归模型，绘制ROC曲线评估模型预测效果，使用SPSS 26.0统计学软件进行数据分析。结果通过分析109例(其中轻型41例，重症68例)HFMD患儿的临床资料发现，体温≥38.9 ℃(OR=2.943, 95% CI：1.099~7.884)、精神差(OR=5.899, 95% CI：2.130~16.339)、外周血白细胞升高(OR=4.386, 95% CI：1.420~13.541)、脑电图异常(OR=4.502，95% CI：1.714~11.821)为重症HFMD的独立危险因素(依次用X₁、X₂、X₃、X₄表示)，预测模型的回归方程为Logit(P)=-2.893+1.079X₁+1.775X₂+1.478X₃+1.504X₄，该模型灵敏度为61.0%，特异度为83.8%，绘制ROC曲线对应的曲线下面积(AUC)为0.843，95% CI为0.768~0.917。结论体温≥38.9 ℃、精神差、外周血白细胞升高、脑电图异常为重症HFMD的独立危险因素，可构建预测HFMD重症的logistic回归模型。
- 手足口病 /
- 重症 /
- 危险因素 /
- 儿童
Abstract: Objective To observe the primary laboratory examination results of children with severe hand-foot-mouth disease (HFMD), determine their risk factors and establish a prediction model to provide early diagnosis and timely HFMD treatment. Methods Children with HFMD (including clinical diagnosis cases and confirmed cases) were included in the study. They were admitted to the First Affiliated Hospital of Bengbu Medical College from January 2019 to December 2019. The clinical symptoms, signs and major laboratory indicators were analysed, and statistically significant terms were further processed via multifactor logistic regression to build a regression model. ROC curves were drawn to evaluate the predictive effect of the model. Data were analysed using SPSS 26.0 software. Results The clinical data of 109 HFMD cases (including 41 mild cases and 68 severe cases), showed that body temperature of ≥ 38.9 ℃ (OR=2.943, 95% CI: 1.099-7.884), poor spirit (OR=5.899, 95% CI: 2.130-16.339), increased peripheral blood white blood cells (OR=4.386, 95% CI: 1.420-13.541) and abnormal electroencephalogram (OR=4.502, 95% CI: 1.714-11.821) were independent risk factors for severe HFMD. The regression equation of the prediction model was Logit (P)=-2.893+1.079X₁+1.775X₂+1.478X₃+1.504X₄. The sensitivity of the model was 61.0%, and its specificity was 83.8%. The area under the curve corresponding to the ROC curve was 0.843 (95% CI: 0.768-0.917). Conclusion Body temperature of ≥ 38.9 ℃, poor spirit, increased peripheral blood white blood cells and abnormal electroencephalogram are independent risk factors for severe HFMD. These risk factors can be used to establish a predictive logistic regression model for severe HFMD.
- Hand-foot-mouth disease /
- Severe cases /
- Risk factors /
- Children

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图 1 HFMD患儿发病月份的比较

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图 2 HFMD患儿发病年龄的比较

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图 3 预测模型的ROC曲线

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表 1 2组HFMD患儿临床资料比较[例(%)]

组别	例数	体温(℃)			皮疹部位(手、足、口、臀)				精神差	流涎	咳嗽、咳痰、肺部湿啰音等	紫绀、末梢循环差等
组别	例数	T < 37.5	37.5≤T < 38.5	38.5≤T < 39.5	单个部位	2个部位	3个部位	4个部位	精神差	流涎	咳嗽、咳痰、肺部湿啰音等	紫绀、末梢循环差等
轻型	41	2(4.9)	28(68.3)	11(26.8)	12(29.3)	11(26.8)	17(41.5)	1(2.4)	9(22.0)	21(51.2)	18(43.9)	0(0.0)
重症	68	4(5.9)	21(30.9)	43(63.2)	17(25.0)	15(22.1)	29(42.6)	7(10.3)	43(63.2)	47(69.1)	33(48.5)	0(0.0)
χ²值		15.191			2.467				17.475	3.492	0.220
P值		0.001			0.497				< 0.001	0.062	0.639

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表 2 2组HFMD患儿实验室指标比较(x ±s)

组别	例数	脑电图异常[例(%)]	EV71IgM抗体[例(%)]	CA16IgM抗体[例(%)]	合并其他病原菌[例(%)]	WBC(×10⁹/L)	NE%(%)	PA(mg/dL)	GLU(mmol/L)
轻型	41	15(36.6)	3(7.3)	2(4.9)	10(24.4)	9.47±3.54	46.9±17.2	136.78±27.81	4.91±1.39
重症	68	52(76.5)	9(13.2)	13(19.1)	27(39.7)	11.68±3.94	55.1±15.6	132.74±34.08	5.99±1.70
统计量		17.180^a	0.914^a	3.253^a	2.676^a	8.620^b	6.650^b	0.412^b	11.795^b
P值		< 0.001	0.339	0.071	0.102	0.004	0.011	0.522	0.001

组别	例数	CKMB(U/L)	CR(μmol/L)	UREA(mmol/L)	ALT(U/L)	AST(U/L)	LDH(U/L)	RBP(mg/L)
轻型	41	31.05±13.33	31.54±7.58	3.65±1.01	20.98±12.78	38.07±9.40	143.37±45.97	18.93±6.18
重症	68	32.25±16.45	29.81±7.83	3.57±0.95	17.82±9.34	36.31±9.92	223.91±39.29	17.85±5.14
统计量		0.156^b	1.277^b	0.161^b	2.197^b	0.841^b	94.459^b	0.957^b
P值		0.693	0.261	0.689	0.141	0.361	< 0.001	0.330

组别	例数	NLR[M(P₂₅, P₇₅)]	PLR[M(P₂₅, P₇₅)]	CK[M(P₂₅, P₇₅), U/L)]		CRP[M(P₂₅, P₇₅), mg/L)]		PCT[M(P₂₅, P₇₅), ng/mL)]
轻型	41	1.05(0.55, 1.84)	87.54(62.95, 104.74)	82.50(59.50, 105.50)		8.10(3.90, 17.90)		0.34(0.16, 0.77)
重症	68	1.80(1.11, 2.76)	85.86(64.57, 114.89)	86.00(58.00, 120.00)		14.80(5.03, 22.38)		0.35(0.18, 1.07)
统计量		-1.429^c	-1.486^c	-1.615^c		-1.454^c		-0.613^c
P值		0.153	0.137	0.106		0.146		0.540
注：^a为χ²值，^b为t值，^c为U值。

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表 3 重症HFMD患儿的多因素logistic回归分析

变量	B	SE	Wald χ²	P值	OR(95% CI)
体温≥38.9 ℃	1.079	0.503	4.610	0.032	2.943(1.099~7.884)
精神差	1.775	0.520	11.658	0.001	5.899(2.130~16.339)
WBC升高	1.478	0.575	6.605	0.010	4.386(1.420~13.541)
脑电图异常	1.504	0.493	9.328	0.002	4.502(1.714~11.821)
常量	-2.893	0.738	15.344	< 0.001
注：变量的赋值方法如下，发生重症HFMD是=2，否=1；体温≥38.9 ℃=2， < 38.9 ℃=1；精神差=2，精神一般或良好=1；白细胞计数>10×10⁹/L=2，正常=1；脑电图异常=2，脑电图正常=1。

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表 4 重症HFMD患儿的预测效果评估(例)

实际结果	例数	模型结果
实际结果	例数	轻型病例	重症病例
轻型病例	41	25	16
重症病例	68	11	57

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