目的 比较普通型、重型及危重型手足口患儿的临床特征与高危因素的差异,探求重型特别是危重型手足口患儿的典型识别因素。方法 回顾性分析2008年1月-2011年12月收治的128例(危)重型手足口患儿临床资料,其中重型104例,危重型24例(死亡9例),并收集同期实验室确诊的143例普通型病例资料进行成组匹配,对比普通型病例与(危)重型病例、重型病例与危重型病例的临床特征与高危因素的区别,采用Logistic回归模型探求重型病例与危重型病例典型的临床特征差异。结果 1)普通病例与(危)重病例在发病年龄、是否首次确诊、发热时间及热峰值、皮疹性质、是否出现中枢神经系统症状、胸片与心血管表现、实验室指标及病原学方面存在明显差别(P＜0.05);2)危重型手足口患儿皮疹不典型比例、出现神经系统症状比例、心血管与胸片表现异常比例、EV71感染构成及实验室检测指标方面高(重)于重型患儿(P＜0.05);3)Logistic模型显示非典型皮疹、神经系统症状、胸片渗出性表现、空腹血糖升高、血压升高、EV71感染是危重型手足口患儿的独立危险因素(P＜0.05)。 结论 临床要高度关注3岁以下皮疹不典型、且胸片、血压、血糖异常的EV71型感染病例的患儿,这些指标的出现异常提示患儿病情有恶化趋势。

Objective To investigate the typical high risk factors of severe hand,foot and mouth disease(HFMD),especially on critical danger cases through comparison between ordinary type HFMD cases and severe & critical danger cases. Methods Retrospective study was conducted on 128 admitted severe(n=104) & critical danger (n=24,including 9 deaths)HFMD cases from Jan.2008 to Dec.2012,and 128 cases were matched with 143 laboratory confirmed general HFMD,and clinical features and high risk factors were compared between 2 groups above,then,logistic regression was applied to investigate typical clinical features & high risk factors of critical danger HFMD cases. Results 1)Indicators of onset age,whether or not diagnosed at first medical visit,heating time and thermal peak,rash nature,presence of central nervous symptoms(CNS),chest radiographic and cardiovascular manifestations,laboratory defective indexes and proportion of EV71 infection were different between general cases and severe & critical danger cases(P<0.05);2)Atypical rash ratio,neurological symptoms,cardiovascular and chest X-ray manifestations,proportion of EV71 infection and laboratory defective indexes of critical danger cases were more serious or higher than those of severe cases(P<0.05).3)Atypical rashes,neurological symptoms,chest radiography exudative manifestations,elevation of FPG and BP,EV71 infection were severe independent risk factors of critical danger HFMD cases revealed by Logistic regression model (P<0.05). Conclusion Attention should be paid to children with less than 3 years old,atypical rashes and abnormalities of chest X-ray,BP,FPG,etc,those indexes presenting abnormally are deteriorating tips for HFMD cases.