手足口病重症病例评分标准研究

目的 探讨评价手足口病重症程度的评分标准,为客观筛查重症病例、统一重症病例判定标准提供依据,并为临床救治提供参考.方法 选择安徽省阜阳市两家手足口病定点医院在2008年3-6月筛查的所有重症病例,并随机选择部分轻症病例为研究对象,利用事先制定的评分标准,对病例的病情进行统一评分.采用ROC曲线对评分标准的诊断价值进行客观评价,评价所用金标准主要依据ICU、气管插管和临床结局等制定,并利用灵敏度、特异度和约登指数界定危重、重症和轻症病例的判定分值.结果 97%(34例)的轻症病例评分在6分以下,88%(24例)的行气管插管和机械通气的病例评分在6分以上,79%(11例)死亡病例评分在10分以上.重症病例和轻症病例的ROC曲线下面积为0.90(95%CI:0.83～0.98),危重病例与重症+轻症病例的ROC曲线下面积为0.95(95%CI:0.92～0.98),综合考虑灵敏度和特异度,当评分为4分时,此时对重症病例的判断效果最好,灵敏度为0.94、特异度为0.68、约登指数为0.62;当评分为6分时,此时对危重病例的判断效果最好,灵敏度为0.92、特异度为0.84、约登指数为0.76.结论 手足口病重症程度评分标准可量化判定病情严重程度,对病例的诊断价值很高.

Study on the score criteria of severe hand, foot and mouth disease cases

Objective To explore the score criteria of severe hand, foot and mouth disease (HFMD) cases and to provide evidence for unified criteria and treatment on severe HFMD cases.Methods All severe cases and partial mild cases reported by two designated hospitals of HFMD in Fuyang during March to June, 2008 were scored by the methods of criteria constructed in advance.ROC curve was adopted to evaluate the score criteria and the gold standard was defined according to ICU, intubation and clinical outcomes, etc. Sensitivity, specificity and Youden' s index were used to determine the division scores on critical, severe and mild cases. Results 97% of the cases (34 cases) were scored less than 6 points. 88% of cases (24 cases) who were intubated or mechanical ventilated had the scores of 6 points or higher. 79% of deaths (11 cases) were scored 10 points or higher. The area of receiver operation characteristic (ROC) curve was 0.90 (95% CI: 0.83-0.98)between severe and mild cases and the area of ROC curve was 0.95 (95%CI: 0.92-0.98) between critical and severe, mild cases. When comprehensively considering the sensitivity and specificity,severe cases were best judged when score was 4 points (sensitivity, specificity and Youden' s index were 0.94, 0.68 and 0.62 respectively). When score was 6 points, critical cases were judged very well (sensitivity, specificity and Youden' s index were 0.92, 0.84 and 0.76 respectively). Conclusion Score criteria could be quantified to determine the degree of seriousness and with high-value for diagnosis on HFMD.