炎症因子在手足口病重症和重症天数判断中的应用  

Application of the inflammatory factor in determination of severe hand-foot-and-mouth disease cases and duration

作　　者：党德建 朱杰辉[1] 张超[1] 晋乐飞 周广远[2] 申远方[3] 郗园林[1] 陈帅印[1] 段广才[1] 

机构地区：[1]郑州大学公共卫生学院 [2]新乡医学院公共卫生学院 [3]郑州市儿童医院感染性疾病科

出　　处：《现代预防医学》2017年第20期3817-3821,共5页Modern Preventive Medicine

基　　金：国家自然科学基金项目(No.81573205;81172740)

摘　　要：目的研究血清炎症因子水平在重症手足口病(HFMD)及手足口病患者重症天数判断中的作用。方法使用受试者工作曲线(ROC曲线)分析炎症因子水平与重症手足口病关系,并使用曲线下面积(AUC)评价判别效果。采用分类和回归树(CART)模型和支持向量机(SVM)模型对手足口病患者重症天数进行判断,并使用交叉验证评价模型泛化能力。结果 ROC曲线分析结果表明白细胞介素-4(IL-4)对于判断轻重症的效果最好(AUC:0.989),IL-6、肿瘤坏死因子-α(TNF-α)、IL-10、干扰素-γ(INF-γ)和IL-17的效果依次递减,AUC值分别为0.933、0.898、0.882、0.853和0.523。CART模型和SVM模型对于手足口病患者重症天数判断的一致率分别为87.69%和95.38%,进行5折交叉验证得到模型的一致率分别为77.49%和81.40%。结论使用血清炎症因子水平对于手足口病重症有很好的判别效果,且对于判断手足口病患者重症天数也有较好的效果。Objective The study aimed to assess the application of the inflammatory factor in determination of severe hand- foot-and-mouth disease （HFMD） cases and duration. Methods Receiver operating characteristic （ROC） curve was used to analyze the correlation between inflammatory factor level and HFMD, and the area under the curve （AUC） was used to evaluate determination effect. Classification and regression tree （CART） model and support vector machine （SYM） model were used to determine disease duration of a severe HFMD case, and cross validation was used to evaluate generalization ability of the models. Results The result of ROC curve analysis showed that IL-4 presented a best performance in determining severity （AUC： 0.989）, and was followed by IL-6, TNF-α, IL-1, INF-γ and IL-17, the AUCs of which were 0.933, 0.898, 0.882, 0.853, and 0.523, respectively. The concordance rates of the CART model and SVM model in determining duration of a severe HFMD case were 87.69% and 95.38%, respectively, and the concordance rates of the models adjusted with 5-fold cross validation were 77.49% and 81.4%, respectively. Conclusion The level of serum inflammatory factor is a strong indicator for determining a severe HFMD case as well as duration of a severe HFMD case.

关 键 词：手足口病 炎症因子 判别模型 

分 类 号：R181.23[医药卫生—流行病学]