危险因素评分模型在识别重症手足口病方面的初步探索  

Identification of severe hand-foot-mouth disease based on risk factor score model:a preliminary study

作　　者：王斌[1] 冯慧芬[2] 黄平[1] 申远方[3] 赵敬 易佳音 WANG Bin , FENG Hui - fen, HUANG Ping, SHEN Yuan - fang, ZHAO Jing, YI Jia - yin(Department of Gastroenterology,Fifth Affiliate Hospital of Zhengzhou University,Zhengzhou,Henan 450052, Chin)

机构地区：[1]郑州大学第五附属医院消化内科,河南郑州450052 [2]郑州大学第五附属医院感染科,河南郑州450052 [3]郑州市儿童医院感染性疾病科,河南郑州450053

出　　处：《现代预防医学》2018年第7期1166-1170,共5页Modern Preventive Medicine

基　　金：国家自然科学基金(81473030);河南省医学科技攻关普通项目(201403130);河南省卫生系统出国研修项目(2015065)

摘　　要：目的建立一个用于评估手足口病重症化的危险因素评分模型。方法收集2015年6月至2017年2月新乡市某医院收治的1 386例确诊为手足口病患儿的病例资料为研究对象,包括普通组876例,重症组510例。将原始数据分割为970例训练样本和416例检验样本。选用SPSS 25.0进行所有数据分析,对训练样本数据进行单因素和多因素Logistic回归分析,将最终筛选出的变量用于构建危险因素评分模型。最后使用检验样本的数据进行验证,通过诊断性ROC曲线比较回归方程模型和危险评分模型的诊断效能。结果最终构建的危险评分模型,包括了居住地农村、发热时间>3天、体温>39℃、白细胞>12×109/L和EV71阳性共5个评分项目,危险分级包括:低度危险(0-2分),中度危险(3-4分)和重度危险(5-7分),其重症手足口病发病风险分别为低危27.01%,中危52.14%,重危95.35%。危险评分模型与回归方程模型诊断效能相近,其曲线下面积分别为0.745和0.751。结论本研究初步建立的危险评分模型相比于传统回归方程模型更具有简便实用性,为后续研究制定更高级别的临床评分量表提供一定的参考价值。Objective To develop a risk score model for assessing severe hand - foot - mouth disease （HFMD）. Methods A total of 1 386 cases of children with HFMD were collected from June 2015 to February 2017 in a hospital of Xinxiang, with 876 cases in general group and 510 cases in severe group. The original data were divided into 970 training samples and 416 test samples. We performed all analyses with SPSS software, version 25.0. The training sample data were analyzed by univariate and multivariate Logistic regression. The predictive variables selected in the end made up a risk score model. Finally, the test sample data were used for validation. The diagnostic efficiency of the regression equation model and risk score model were compared by receiver operating curve （ ROC ）. Results The final risk score model included 5 scoring items ： rural areas of residence, duration of fever 〉 3 days, body temperature 〉 39℃, WBC 〉 12 × 10^9/L and EV71 -positive. The risk classification included low risk （0 -2 points） , moderate risk （3 -4 points） and severe risk （5 -7 points）. The incidence rates of severe HFMD were 27.01% ,52. 14% and 95.35% , respectively. The risk score model and regression equation model had similar diagnostic performance, and areas under the curve were 0. 745 and 0.751, respectively. Conclusion The risk score model established in this study is more convenient and practical than the traditional regression equation model, and it provides a reference for further research to develop an advanced clinical rating scale.

关 键 词：重症手足口病 危险评分模型 预测 

分 类 号：R195[医药卫生—卫生统计学]