648例手足口病回顾性分析
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Logistic regression analysis of 648 patients with hand foot and mouth disease
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    摘要:

    目的:探讨重症手足口病的危险因素-方法:对2008年4月~2009年6月留观和住院的手足口病患儿的临床表现进行回顾性分析-结果:对全部被调查者的11个项目进行单因素相关分析,其中8项有显著性(P < 0.05),分别是精神差-惊跳-嗜睡-发热天数≥3天-热峰≥38.5℃-呕吐-头痛-皮疹分布(无口腔溃疡)-热程≥3天的灵敏度-特异性-阳性预测值-阴性预测值分别为:61.8%,80.2%,58.9%,82.0%;热峰≥38.5℃的灵敏度-特异性-阳性预测值-阴性预测值分别为:39.8%,88.4%,91.6%,31.6%;惊跳的灵敏度-特异性-阳性预测值-阴性预测值分别为:72.7%,80.2%,96.6%,90.3%;呕吐的灵敏度-特异性-阳性预测值-阴性预测值分别为:82.6%,76.4%,40.2%,95.8%;精神的灵敏度-特异性-阳性预测值-阴性预测值分别为:67.4%,90.2%,82.2%,80.4%-精神差是中枢神经系统感染的独立危险因素-结论:精神差-惊跳-嗜睡-发热天数≥3天-热峰≥38.5℃-呕吐-头痛-皮疹分布(无口腔溃疡)为手足口病的危险症状,确定这些危险症状,有助于早期识别重症病例,早期治疗,降低死亡率-

    Abstract:

    Objective:To investigate the risk factors of hand foot and mouth disease(HFMD). Methods:Data collected through a prospective clinical study of HFMD conducted between 2008 and 2009 were examined to identify risk factors associated with neurological involvement in children with HFMD. Results:There were significantly differencs in listlessness,start,history of lethargy,total duration of fever≥3 days,peak temperature ≥38.5℃,vomit,headache,and absence of mouth ulcers. Listlessness was identified as an independent risk factor for neurological involvement in the analysis of 648 children admitted to hospital. Total duration of fever ≥3 days,peak temperature≥38.5℃,start,vomit,and listlessness had the sensitivity,specificity,positive predictive value (PPV) and negative predictive value(NPV) respectively:61.8%,80.2%,58.9%,82.0%;39.8%,88.4%,91.6%,31.6%;72.7%,80.2%,96.6%,90.3%;82.6%,76.4%,40.2%,95.8%;67.4%,90.2%,82.2%,80.4%. Conclusion:Listlessness,start,history of lethargy,total duration of fever ≥3 days,peak temperature≥38.5℃,vomit,headache,and absence of mouth ulcers were identified as clinical risk factors to help detect children at risk of neurological involvement. These risk factors may serve as a guide to clinicians to decide the need for hospitalization,further investigation,close monitoring for disease progression,and decrease of mortality in children with HFMD.

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石小华,胡〓静,喻文亮,于〓毅.648例手足口病回顾性分析[J].南京医科大学学报(自然科学版),2010,(1):87-91

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  • 收稿日期:2009-06-03
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