血清S-100β水平和小儿危重病例量表评分预测手足口病并发脑炎患儿预后的价值研究  

Values of Serum S-100β Level and Pediatric Critical Illness Scale in Predicting Hand- foot- mouth Disease Children Complicated With Encephalitis

作　　者：熊燚 王健 魏笛 冯亚 

机构地区：[1]贵州省遵义市第二人民医院急诊科,563000 [2]贵州省遵义市红花岗区疾病预防控制中心

出　　处：《中国全科医学》2016年第23期2780-2784,共5页Chinese General Practice

基　　金：贵州省卫生厅科学技术基金项目(gzwkj2013-1-060);遵义市科学技术基金项目[遵义市科合社字(2013)37号]

摘　　要：目的探讨血清S-100β水平与小儿危重病例量表（PCIS）评分对手足口病（HFMD）并发脑炎患儿预后评估的价值。方法选取2012年12月—2014年12月遵义市第二人民医院收治的HFMD患儿190例为研究对象,根据是否并发脑炎,将患儿分为HFMD并发脑炎组（60例）和HFMD普通组（130例）。另选取同期本院体检中心体检健康的儿童40例为对照组。收集HFMD并发脑炎患儿入院24 h内各项资料,并依据PCIS对患儿进行病情危重程度评分,据此将患儿分为非危重、危重、极危重。患儿于入院后12 h、对照组体检时抽取空腹静脉血3 ml检测S-100β水平及白细胞计数（WBC）,记录HFMD患儿住院期间死亡情况。结果各组S-100β水平、WBC比较,差异均有统计学意义（P〈0.05）;其中,HFMD并发脑炎组S-100β水平高于HFMD普通组及对照组,HFMD普通组与HFMD并发脑炎组WBC高于对照组（P〈0.05）。HFMD并发脑炎组病死率为20%（12/60）,高于HFMD普通组的4.6%（6/130）（χ~2=18.32,P〈0.05）。不同危重程度的HFMD并发脑炎患儿S-100β水平及病死率比较,差异均有统计学意义（P〈0.05）;其中危重者S-100β水平及病死率高于非危重者,极危重者S-100β水平及病死率高于非危重和危重者（P〈0.01）。HFMD并发脑炎患儿S-100β水平与PCIS评分呈负相关（r=-0.478,P〈0.01）。S-100β水平预测HFMD并发脑炎患儿死亡的受试者工作特征（ROC）曲线下面积为0.888〔95%CI（0.834,0.947）,P〈0.01〕,取临界值为2.91μg/L时,灵敏度为84.46%,特异度为82.50%。PCIS评分预测HFMD并发脑炎患儿死亡的ROC曲线下面积为0.873〔95%CI（0.808,0.938）,P〈0.01〕,取临界值为69分时,灵敏度为83.10%,特异度为81.24%。结论血清S-100β水平和PCIS评分可特异反映HFMD并发脑炎患儿严重程度,对预测HFMD并发脑炎患儿预后具有较高的准确性。Objective To investigate the value of serum S-100β level and pediatric critical illness scale（ PCIS） in prognostic evaluating the hand- foot- mouth disease（ HFMD） children complicated with encephalitis. Methods 190 children with HFMD,who received treatment in the Second People＇ s Hospital of Zunyi from December 2012 to December 2014,were enrolled as the research objects in this study. Based on whether children were complicated with encephalitis,we divided the children into HFMD complicated with encephalitis group（ 60 cases） and HFMD general group（ 130 cases）. Other 40 children,who were regarded as healthy after physical examination in the physical examination center of this hospital at the same period,were included as the control group. We collected necessary information of the HFMD children complicated with encephalitis within the 24- hour after their being admitted into the hospital,and scored their critical illness condition based on PCIS,then divided the children as non- critical illness cases,critical illness cases and extremely critical illness cases. S-100β and WBC were detected by the extracted 3 ml fasting blood,which were got from HFMD children 12 h after their being admitted into the hospital and from the physical examination of control group. Also HFMD children＇s death duration of hospital stay was recorded.Results There were significant difference in S-100β level and WBC among the different groups（ P〈0. 05）; the S-100β level of HFMD complicated with encephalitis group was higher than that of the HFMD general group and the control group,and the WBC of the HFMD general group and the HFMD complicated with encephalitis group was higher than that of the control group,which showed significant differences（ P〈0. 05）. The fatality rate of the HFMD complicated with encephalitis group was 20%（ 12 /60）,which was higher than 4. 6%（ 6 /130） in the HFMD general group,which showed significant differences（ χ2= 18. 32,P〈0. 05）. There was significant difference in the

关 键 词：手足口病 脑炎 S-100Β 小儿危重病例量表 预后 

分 类 号：R512.5[医药卫生—内科学]