258例手足口病病例分析

发布时间：2018-04-29 10:26

本文选题：手足口病 + 重症　；参考：《郑州大学》2017年硕士论文

【摘要】：目的:通过研究手足口病重症型和普通型的流行病学、临床特征和实验室检查结果,探讨手足口病的发病特点及血液生化检验重症危险因素,为手足口病重症早期识别和干预治疗提供理论依据,以降低死亡率,减少后遗症,提高治愈率。方法:选取2013年1月1日至2015年12月31日期间在河南省三门峡市中心医院感染性疾病科收治住院的258例确诊手足口病患儿的病例资料为研究对象,其中重症型67例,普通型191例,对其流行病学、临床特征和实验室检查结果进行回顾性分析。采用χ2检验和t检验比较两组的差异,运用Logistic回归分析手足口病血液生化检验重症危险因素。结果:1.手足口病4~7月集中发病。男女比约为1.46:1(153:105),两组患儿性别构成比较差异无统计学意义(P0.05)。1~3岁年龄组发病人数最多(66.7%,172/258),两组患儿年龄比较差异无统计学意义(P0.05)。农村患儿多于城市患儿,两组患儿地域特征比较差异无统计学意义(P0.05)。散居儿童发病多于幼托儿童,两组患儿地域分布特征比较差异无统计学意义(P0.05)。多数患儿无明确接触史,两组患儿接触史比较差异无统计学意义(P0.05)。2.重症组以中等度热、高热为主,普通组以中等度热、低热为主,两组患儿入院前发热比较差异无统计学意义(P0.05),热程比较差异有统计学意义(P0.05)。两组患儿皮疹分布类型均以手+足+臀+口部,手+足+口部,手+足部为多见,皮疹最常累及部位依次是手、足、口腔和臀部,出现单一部位的皮疹以手部最常见,其次是口、足和臀部。两组患儿皮疹分布部位和部位数比较差异无统计学意义(P0.05),入院前出疹时间比较差异有统计学意义(P0.05)。手足口病患儿多见同时出现发热和皮疹,两组患儿发热与出疹时间关系比较差异无统计学意义(P0.05)。67例重症患儿均有不同程度神经系统受累表现,两组患儿神经系统受累症状比较差异有统计学意义(P0.05)。两组患儿在咳嗽、流涕等症状和腹痛、腹泻等症状方面比较差异无统计学意义(P0.05);在食欲不振和持续高热方面比较差异有统计学意义(P0.05)。3.两组患儿白细胞计数、红细胞计数、血小板计数、血红蛋白,肝功能(ALT、AST、GGT),心肌酶谱(CK、CK-MB、LDH、α-HBDH),肾功能(Urea、CRE)、血清电解质(Ca2+)结果比较差异无统计学意义(P0.05);CRP,血糖,血清电解质(K+、Na+、Cl-)结果比较差异有统计学意义(P0.05)。两组患儿EV71-RNA检测结果比较差异无统计学意义(P0.05)。两组患儿尿酮体结果比较差异有统计学意义(P0.05)。本研究资料中共有85例手足口病患儿行脑脊液常规和生化检验,其中重症组60例,普通组25例,两组患儿CSF-WBC,CSF-P,潘氏实验结果比较差异有统计学意义(P0.05);CSF-GLU、CSF-CL、ADA比较差异无统计学意义(P0.05)。4.Logistic回归单因素分析结果可见两组患儿血液生化检验项目中CRP、CK、GGT、Na+差异有统计学意义(P0.05),多因素分析结果显示CRP升高(OR=2.863,P0.05)、GGT降低(OR=2.040,P0.05)为手足口病重症危险因素,CK升高(OR=0.386,P0.05)为保护因素。结论:1.手足口病患儿多无明确接触史,同时出现发热和皮疹多见;重症患儿入院前发热和出疹时间更长,发热程度可不高,白细胞计数可无明显增高。2.CRP升高、GGT降低为手足口病重症危险因素,CK升高为保护因素。
[Abstract]:Objective: by studying the epidemiology, clinical features and laboratory examination results of the severe and common type of hand foot and mouth disease, the characteristics of hand foot and mouth disease and the critical risk factors of blood biochemical test are discussed in order to provide theoretical basis for the early recognition and intervention treatment of HFMD so as to reduce the mortality, reduce the sequelae and improve the cure rate. Methods: from January 1, 2013 to December 31, 2015, 258 cases of children with hand foot and mouth disease in the infectious diseases department of Sanmenxia Central Hospital of Henan province were selected as the subjects, including 67 cases of severe type and 191 cases of common type. The epidemiological, clinical features and laboratory examination results were analyzed retrospectively. The difference between the two groups was compared with the x 2 test and t test. Logistic regression was used to analyze the severe risk factors of the blood biochemical test of hand foot and mouth disease. Results: 1. hand foot and mouth disease was concentrated in 4~7 months. The ratio of men and women was 1.46:1 (153:105). There was no statistical difference between the two groups (P0.05) the largest number of patients (66.7%, 172/258) in the.1~3 age group. There was no statistical difference between the two groups of children (P0.05). There were more children in rural areas than in urban children. There was no significant difference in regional characteristics between the two groups (P0.05). The incidence of scattered children was more than that of young children. There was no statistical significance in the geographical distribution of the two groups (P0.05). The majority of children had no definite contact history and two groups of children. There was no significant difference in the history of contact history (P0.05).2. severe group with moderate fever, high fever, moderate fever and low fever in the general group. There was no significant difference in the fever between the two groups (P0.05), and the difference in the heat range was statistically significant (P0.05). The types of rash in the two groups were all with hand + foot + hip + mouth, hand + foot + The most common parts of the skin rash were hand, hand, foot, mouth and hip, and the most common rash in the hand, followed by the mouth, foot and hip. There was no significant difference between the two groups of skin rashes in the two groups (P0.05). The time of the rash before admission was statistically significant (P0.05). Children with foot and mouth disease found fever and rash at the same time. There was no significant difference in the relationship between fever and rash time in the two groups (P0.05).67 cases had different degrees of nervous system involvement, and there was a significant difference in the symptoms of nervous system involvement in the two groups (P0.05). The two groups of children were in cough, runny nose and other symptoms. There was no significant difference in symptoms such as abdominal pain and diarrhea (P0.05), and there was significant difference in loss of appetite and persistent hyperthermia (P0.05) the leukocyte count, erythrocyte count, platelet count, hemoglobin, liver function (ALT, AST, GGT), myocardial enzyme (CK, CK-MB, LDH, alpha -HBDH), renal function (Urea, CRE), blood, and blood in.3. two groups There was no significant difference in the results of Ca2+ (P0.05); CRP, blood glucose, serum electrolyte (K+, Na+, Cl-) had a statistically significant difference (P0.05). There was no significant difference in the results of EV71-RNA detection in the two groups (P0.05). There was a significant difference in the results of the two groups of children with ketone body (P0.05). There were 85 cases of hand foot and mouth disease in children with routine and biochemical test of cerebrospinal fluid, of which 60 cases in severe group, 25 cases in common group, two groups of CSF-WBC, CSF-P, and Pan's experimental results were statistically significant (P0.05); CSF-GLU, CSF-CL, ADA were not statistically significant (P0.05).4.Logistic regression single factor analysis showed the blood of two groups of children The differences of CRP, CK, GGT and Na+ were statistically significant (P0.05). The results of multivariate analysis showed that CRP was elevated (OR=2.863, P0.05), GGT decreased (OR=2.040, P0.05) was a critical risk factor for hand foot and mouth disease, and CK increased as a protective factor. Conclusion: 1. children with hand foot and mouth disease have no definite contact history, and there are fever and rash at the same time. It was found that the fever and rash time of severe children were longer, the degree of fever was not high, the white blood cell count could not increase obviously.2.CRP, the decrease of GGT was the risk factor of hand foot and mouth disease, and the increase of CK was the protective factor.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.1

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