2种危重症评分在手足口病并脑炎病情评估中的应用研究

目的 探讨小儿危重病例评分(PCIS)及第三代小儿死亡危险评分(PRISM Ⅲ)在儿童手足口病并脑炎病情评估及预后判断中的应用价值。 方法 分别用PCIS及PRISM Ⅲ对2010年收住院的手足口病并脑炎患儿进行评分，分非危重组、危重组和极危重组，比较各组间的死亡率，运用ROC曲线比较两者在预判手足口病并脑炎患儿死亡风险的特异性和灵敏度。 结果 ①PCIS评分:3组死亡率比较差异有统计学意义(8/466,10/12,5/5,χ2=93.099，P＜0.001)；②PRISM Ⅲ评分:3组比较死亡率，差异亦有统计学意义(4/458,4/7,15/18,χ2=114.579，P＜0.001)；③2种评分的非危重组、危重组和极危重组组间死亡率比较，差异均无统计学意义(1.72% vs. 0.87%,χ2=1.282，P=0.258,88.24% vs. 76.00%,χ2=0.349，P=0.555)；④Logistic回归分析显示:PCIS各评分指标中，心率、血压(收缩压)及肾功能，PRISM Ⅲ各评分指标中，神志状态及血糖对手足口病死亡风险预测作用较强(P均＜0.05)。⑤ROC曲线下面积分别为:PCIS评分0.929，PRISM Ⅲ评分0.985。 结论 PCIS和PRISM Ⅲ均可用于手足口病并脑炎患儿病情的评估，两者在预测其死亡风险方面有较高的特异性和灵敏度。 

Application of two critical illness scores in assessment of hand-foot-mouth disease combined with encephalitis

Objective To investigate the advantages ofpediatric critical illness score(PCIS) and the pediatric risk of mortalityⅢ(PRISM Ⅲ) in the judgment of the severe extent and prognosis in children with hand-foot-mouth disease and encephalitis. Methods PCIS and PRISM Ⅲ were sued to assess the severity of children with hand-foot-mouth disease and encephalitis.The patients were divided into three groups(very critical,critical,noncritical group) according to the scores.The mortality was calculated and compared among the three groups.The specificity and sensitivity of PCIS and PRISM Ⅲ in the judgment of the death risk in children hand-foot-mouth disease combined with encephalitis were compared through measuring the area under the ROC curve(AUC). Results ①PCIS score:To compare the mortality of the groups of non-critical,critical and very critical subgroups,the difference was statistically significant(8/466,10/12,5/5,χ2=93.099,P＜0.001).②PRISM Ⅲ score: To compare the mortality of the corresponding groups,the difference was statistically significant(4/458,4/7,15/18,χ2=114.579,P＜0.001).③The comparison between PCIS and PRISMⅢ score: the differences were not statistically significant in mortality between the two groups of non-critical,critical and critical subgroups,respectively(1.72% vs. 0.87%,χ2=1.282,P=0.258,88.24% vs. 76.00%,χ2=0.349,P=0.555).④Multiple logistic regression analysis revealed heart rate,blood pressure(systolic blood pressure) and renalfunction of PCIS sore and the state of consciousness and bloodglucose of PRISM Ⅲ score had more effective prediction of the death risk(P＜0.05,respectively).⑤The area under the ROC curve(AUC) for PCIS and PRISMⅢ were 0.929 and 0.985,respectively. Conclusion PCIS and PRISM Ⅲ score,with high specificity and sensitivity,can be used in the judgment of the severe extent and prognosis of children with hand-foot-mouth disease and encephalitis.