危重症手足口病的危险因素分析  

Analysis of Risk Factors in Critical Cases of Hand-Foot-Mouth Disease

作　　者：李尧[1] 徐晓欧 LI Yao;XU Xiaoou(Department of Infectious Disease,Shenyang 110004,China;Department of Emergency,Shengjing Hospital Affiliated to China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院感染科,沈阳110004 [2]中国医科大学附属盛京医院急诊科,沈阳110004

出　　处：《医学综述》2020年第20期4143-4146,4152,共5页Medical Recapitulate

摘　　要：目的探讨危重症手足口病的危险因素。方法选取2017年1月至2019年12月中国医科大学附属盛京医院收治的13814例手足口病患儿作为研究对象,采用回顾性巢式病例对照研究方法将发生危重症手足口病的患儿作为观察组(n=112),按照观察组1∶2的比例在非危重症患儿中随机匹配对照组(n=224)。收集两组患儿的相关临床资料,采用单因素和二元Logistic回归分析危重症手足口病的危险因素。结果观察组患儿年龄≤3岁、起病>3 d后就诊、体温>39℃及热程>3 d的比例高于对照组,而散居儿童及居住于城镇的比例低于对照组(P<0.05)。观察组患儿白细胞计数、空腹血糖和白细胞介素-6水平高于对照组[(15.8±4.0)×10^9/L比(11.2±5.4)×10^9/L、(6.9±1.2)mmol/L比(5.4±1.2)mmol/L、(286.6±23.6)ng/L比(113.8±38.0)ng/L](P<0.05),而中性粒细胞、淋巴细胞百分比低于对照组(0.60±0.16比0.65±0.15、0.32±0.05比0.35±0.04)(P<0.05)。二元Logistic回归分析结果显示,患儿年龄≤3岁(OR=3.605,95%CI 1.256~10.348,P=0.017)、居住于农村(OR=0.328,95%CI 0.138~0.780,P=0.012)、起病>3 d后就诊(OR=5.262,95%CI 1.202~23.039,P=0.028)、体温>39℃(OR=4.596,95%CI 1.485~14.223,P=0.008)、热程>3 d(OR=2.165,95%CI 0.919~5.098,P=0.017)、白细胞计数升高(OR=1.256,95%CI 1.141~1.382,P<0.001)、空腹血糖升高(OR=2.435,95%CI 1.687~3.516,P<0.001)及白细胞介素-6升高(OR=1.014,95%CI 1.009~1.018,P<0.001)是危重症手足口病患儿的危险因素。结论患儿年龄≤3岁、居住于农村、起病>3 d后就诊、体温>39℃、热程>3 d、白细胞计数升高、空腹血糖升高及白细胞介素-6升高是危重症手足口病患儿的独立危险因素,早期识别这些因素并进行恰当的临床治疗对降低患儿病死率具有重要意义。Objective To explore the risk factors of critical cases of hand-foot-mouth disease(HFMD).Methods A total of 13814 children with HFMD admitted to Shengjing Hospital of China Medical University from Jan.2017 to Dec.2019 were included.A retrospective nested case-control study method was used to assign the critically ill children into an observation group(n=112),and the non-critically ill children were randomly matched to a control group(n=224)according to the ratio of 1∶2 of the observation group to the control group.The relevant clinical data of the two groups were collected,and single factor and binary Logistic regression were used to analyze the risk factors of critical HFMD.Results The proportions of children in the observation group with the features of≤3 years old,visiting clinic upon onset>3 days later,body temperature>39℃and heat duration>3 days were higher than those of the control group(P<0.05),while the proportion of scattered children and living in cities and towns was lower than that of the control group(P<0.05).The white blood cell count,fast blood sugar and interleukin-6 levels of the observation group were significantly higher than those of the control group[(15.8±4.0)×10^9/L vs(11.2±5.4)×10^9/L,(6.9±1.2)mmol/L vs(5.4±1.2)mmol/L,(286.6±23.6)ng/L vs(113.8±38.0)ng/L](P<0.05),and the percentage of neutrophils and lymphocytes were significantly lower than those of the control group(0.60±0.16 vs 0.65±0.15,0.32±0.05 vs 0.35±0.04)(P<0.05).Binary Logistic regression analysis indicated that the children≤3 years old(OR=3.605,95%CI 1.256-10.348,P=0.017),living in rural areas(OR=0.328,95%CI 0.138-0.780,P=0.012),visiting clinics upon onset>3 days(OR=5.262,95%CI 1.202-23.039,P=0.028),body temperature>39℃(OR=4.596,95%CI 1.485-14.223,P=0.008),heat course>3 d(OR=2.165,95%CI 0.919-5.098,P=0.017),white blood cell count increased(OR=1.256,95%CI 1.141-1.382,P<0.001),fast blood sugar increased(OR=2.435,95%CI 1.687-3.516,P<0.001)and increased IL-6(OR=1.014,95%CI 1.009-1.018,P<0.001)were risk factors f

关 键 词：手足口病 危重症 危险因素 

分 类 号：R512.5[医药卫生—内科学]