重症手足口病的相关危险因素分析

目的探讨重症手足口病的相关危险因素，为重症手足口病早期识别指标体系的建立提供依据。方法选择我院2008年1月至2012年12月间收治的手足121病患儿3168例。回顾性分析患儿的临床表现、实验室检查指标和辅助检查指标，应用单因素分析和多因素Logistic回归分析等方法，筛选重症手足口病的危险因素。结果3168例患儿中一般病例2920例，占92．2％，重症病例248例，占7．8％。单因素分析显示，年龄〈3岁、皮疹不典型、意识障碍、神经反射异常、血压高、体温39℃以上〉3d、毛细血管再充盈时间延长（CRT）〉3s、胸片渗出性病变、WBC〉12×10^9L、血糖〉9mmol／L为重症手足口病的相关因素（P〈0．05）。多因素Logistic回归分析显示，年龄〈3岁、神经反射异常、体温39℃以上〉3d、毛细血管再充盈时间延长（CRT）〉3s、胸片渗出性病变、血糖〉9mmol／L是重症手足口病的独立危险因素（P〈0．05）。结论年龄、神经反射异常、体温39℃以上〉3d、毛细血管再充盈时间延长（CRT）〉3s、胸片渗出性病变、血糖〉9mmol／L可作为小儿重症手足口病的危险因素，临床上应高度重视，密切留意患儿病情转变。

Identification index system for early diagnosis of severe hand foot mouth disease.

Objective To explore the risk factors of severe hand foot mouth disease, to provide basis for early identification index system of severe hand foot mouth disease. Methods A total of 3 168 children of hand foot mouth disease in our hospital from January 2008 to December 2012 were enrolled. The clinical manifestation, laboratory examination and auxiliary examination index were retrospectively analyzed, using the single factor analysis and multivariate Logistic regression analysis to screen risk factors of severe hand foot mouth disease. Results The general case among 3 168 children was 2 920 cases, accounting for 92.2%, with 248 cases of severe cases, accounting for 7.8%. Univariate analysis showed that age 〈3 years old, rash is not typical, disturbance of consciousness, neural reflex abnormalities, high blood pressure, temperature of 39℃ above 〉3 d, capillary refill time （CRT）〉3 s, chest X-ray exudative lesion, WBC〉12 × 10^9/L, glucose 〉9 mmol/L were related factors for severe hand foot and mouth disease （P〈 0.05）. Multivariate Logistic regression analysis showed that the age 〈3 years old, nerve reflex, abnormal temperature of 39℃〉3 d, capillary refill time （CRT） 〉3 s, chest X-ray exudative lesion, glucose 〉9 mmol/L were independent risk factors for severe hand foot mouth disease （P〈0.05）. Conclusion Age, nerve reflex, abnormal temperature of 39℃〉3 d, capillary refill time （CRT） 〉3 s, chest X-ray, blood glucose〉9 mmol/L exudative lesions may be risk factors in children with severe hand foot and mouth disease, which should be paid close attention to.