手足口病中枢神经系统受累患者的临床特点及危险因素分析  

Clinical characteristics and risk factors of patients with hand foot and mouth diseases involving the central nervous system

作　　者：孙蕊芸 张维[1] 李侗曾[1] 梁连春[1] Sun Ruiyun;Zhang Wei;Li Tongzeng;Liang Lianchun(Department of lnfective and Pediatrics,Beijing You＇an Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院感染综合儿科,100069

出　　处：《北京医学》2018年第10期954-957,共4页Beijing Medical Journal

摘　　要：目的探讨手足口病(hand foot and mouth diseases, HFMD)中枢神经系统(central nervous system, CNS)受累患者的临床特点及危险因素。方法选取2017年5～10月于首都医科大学附属北京佑安医院感染综合儿科住院的202例HFMD患者的临床资料,其中CNS受累120例,普通HFMD82例,采用多因素logistic回归分析HFMD患者CNS受累的危险因素。结果对性别、体温高峰(Tmax)、呕吐、惊厥、嗜睡、肢抖易惊、WBC、ALT、AST、随机血糖(GLU)以及病原体进行分析。对呕吐、肢抖易惊、WBC>15×109/L和肠道病毒71型(enterovirus 71, EV71)感染诊断HFMD中枢神经系统受累作ROC曲线分析,AUC为0.876,灵敏度为88.3%,特异度为72%,阳性预测值为88.3%,阴性预测值为72%。结论 HFMD患者CNS受累的临床表现多样,EV71感染是CNS受累的危险因素,呕吐、肢抖易惊、WBC>15×109/L是HFMD累及CNS的早期临床征象,结合危险因素和早期表现有助于尽早诊断HFMD重症病例。Objective To explore the clinical features and risk factors of hand foot and mouth diseases（HFMD） patients involving the central nervous system. Methods The clinical data of 202 HFMD patients who admitted to Department of Infective and Pediatrics, Beijing You’an Hospital from May to October 2017 were analyzed. Among them, the patients of HFMD involving the central nervous system were 120, and the common HFMD patients were 82. Multivariate logistic regression was used to analyze risk factors of HFMD patients involving the central nervous system. Results Gender, Tmax, vomiting, convulsion, drowsiness, trembling and jittery, WBC, ALT, AST, random blood sugar and pathogens were analyzed. Receiver operating characteristic curve（ROC） analysis showed that the areas under ROC curve of vomiting, trembling and jittery, WBC〉15×109/L and EV71 infection was 0.876. The sensitivity and specificity of these indicators were 88.3% and 72%. The positive predictive value and negative predictive value were 88.3% and 72%. Conclusion Patients of HFMD involving the central nervous system have a variety of clinical symptoms and signs. Among them,EV71 infection is the risk factor for HFMD combination the central nervous system. Vomiting, trembling and jittery,WBC〉15×109/L are early clinical symptoms and signs. Risk factors and early clinical symptoms are helpful to diagnose severe HFMD as soon as possible.

关 键 词：手足口病 中枢神经系统 危险因素 临床特点 

分 类 号：R725.1[医药卫生—儿科]