重症手足口病患儿发生神经源性肺水肿的影响因素分析  

Risk Factors of Severe Hand,Foot and Mouth Disease Complicated with Neurogenic Pulmonary Edema

作　　者：刘振青 宋春兰 郭彩丽 李鹏[1] LIU Zhenqing;SONG Chunlan;GUO Caili;LI Peng(Emergency Medicine Department,Zhengzhou University Affiliated Children’s Hospital/Henan Province Children’s Hospital/Zhengzhou Children’s Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州大学附属儿童医院河南省儿童医院郑州儿童医院急诊医学科,河南郑州450000

出　　处：《河南医学研究》2024年第23期4246-4250,共5页Henan Medical Research

摘　　要：目的分析重症手足口病(HFMD)患儿并发神经源性肺水肿(NPE)的影响因素,探究早期预测NPE的实验室指标。方法选取2019年6月至2022年6月郑州大学附属儿童医院ICU收治的符合入组条件的重症HFMD患儿184例,根据患儿病情分为重症HFMD合并NPE组和重症HFMD无NPE组。记录两组患儿入院时临床表现以及血常规、C反应蛋白、血糖、神经元特异性烯醇化酶(NSE)、星形胶质源性蛋白(S100B)、N末端脑钠肽前体(NT-proBNP)等实验室结果,采用SPSS 21.0软件进行数据分析,应用单因素分析比较两组患儿的临床资料;对可能的影响因素进行logistic多元回归分析。结果184例重症HFMD患儿中,重症HFMD无NPE组患儿163例,重症HFMD合并NPE组患儿共21例。单因素结果分析显示,两组患儿在年龄、白细胞水平、NT-proBNP水平方面差异有统计学意义(P<0.05),多因素logistic回归分析显示,NT-proBNP水平是影响重症HFMD并发NPE的独立影响因素。受试者工作特征(ROC)曲线分析显示当NT-proBNP截断值为758.9 ng·L^(-1),灵敏度为85.7%,特异度为92.6%,对于合并NPE的重症HFMD诊断效能最高。结论血清NT-proBNP水平是影响重症HFMD并发NPE的独立影响因素,其检测有助于早期识别重症HFMD并发NPE。Objective To analyze the influencing factors of neurogenic pulmonary edema(NPE)in children with severe hand,foot and mouth disease(HFMD),and explore the laboratory indexes for early prediction of NPE.Methods From June 2019 to June 2022,a total of 184 children with severe HFMD admitted to ICU of Children’s Hospital Affiliated to Zhengzhou University were selected.According to the condition,they were divided into severe HFMD complicated with NPE group and severe HFMD without NPE group.The clinical manifestations,blood routine,C-reactive protein,blood glucose,neuron specific enolase(NSE),S-100B protein,N-terminal pro-brain natriuretic peptide(NT-proBNP)and other laboratory results of the two groups were recorded.The data were analyzed by SPSS 21.0 software,and the clinical data of the two groups were compared by single factor analysis.Logistic multiple regression analysis was carried out on the possible influencing factors.Results Among the 184 children with severe HFMD,there were 163 children with severe HFMD without NPE and 21 children with severe HFMD with NPE.Univariate analysis showed that there were significant differences in age,white blood cell level and NT-proBNP level between the two groups(P<0.05).Multivariate logistic regression analysis showed that NT-proBNP level was an independent influencing factor for severe HFMD complicated with NPE.Receive operating characteristic(ROC)curve analysis showed that when the cutoff value of NT-proBNP was 758.9 ng·L^(-1),the sensitivity was 85.7%and the specificity was 92.6%,which had the highest diagnostic efficiency for severe HFMD with NPE.Conclusion Serum NT-proBNP level is an independent influencing factor of severe HFMD complicated with NPE,and its detection is helpful for early identification of severe HFMD complicated with NPE.

关 键 词：重症手足口病 神经源性肺水肿 影响因素 N末端脑钠肽前体 

分 类 号：R541.63[医药卫生—心血管疾病]