摘要
目的分析手足口病合并脑膜炎的早期预测因素,并探讨避免重复进行腰椎穿刺的可行性。方法将2010至2012年住院治疗的375例手足口病患儿,根据病情分为合并脑膜炎组174例和常规组201例,总结两组病例的临床表现及特点,发现有价值的手足口病合并脑膜炎的早期临床特征性指标,对脑膜炎危险因素行单因素和多因素Logistic回归分析。结果手足口病合并脑膜炎的26项单因素分析中,9项指标具有统计学意义(P<0.05);该9项指标均被选入Logistic逐步回归方程;多因素分析提示,年龄<36月、发热>3 d且热峰逐渐升高、精神软弱、呕吐、惊跳、肢体抖动是手足口病合并脑膜炎的独立风险因素。具有1项及以上风险因素的患儿合并脑膜炎的概率为77.52%(169/218),阳性预测值为77.52%,阴性预测值为96.82%,灵敏度为97.13%,特异度为75.62%,诊断符合率为85.6%。结论具备1项或多项危险因素的患儿应高度警惕合并病毒性脑膜炎;不具备危险因素者,若重复进行腰穿复查,盲目延长疗程,无临床意义。
Objective To investigate the risk factors in children with hand-foot-mouth disease （HFMD） complicated by aseptic meningitis, and to explore the feasibility of avoiding repeated lumber puncture. Methods A total of 375 inpatients with HFMD from 2010 to 2012 were enrolled in this study. They were divided into aseptic meningitis group （174 cases） and control group （201 cases without aseptic meningitis） according to their conditions. The clinical features were summarized, and the valuable early specific characteristics of aseptic meningitis were investigated. The results were statistically analyzed by single factor and multiple factors between aseptic meningitis group and control group. Results In the single factor analysis, 9 of 26 indexes were obviously significant （/＇〈0.05）. Multivariate analysis of these 9 indexes revealed that age younger than 36 months, catching fever over 3 days and gradually increased thermal peak, fatigue, vomiting, frequently trembling ~Jmb and easily being frightened were major risk factors for HFMD with aseptic meningitis. The probability of children with HFMD complicated by aseptic meningitis is 77.52% （169/218） when more than one index was presented. Positive and negative predictive values were 77.52% and 96.82%. Sensitivity, specificity and agreement were 97.13%, 75.62% and 85.60/0, respectively. Conclusions The patients with risk factors should be highly vigilant against HFMD with aseptic meningitis. It is no need to repeat lumberpuncture and prolong course of therapy to ones without risk factors.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2012年第11期1016-1019,共4页
Journal of Clinical Pediatrics
关键词
手足口病
脑膜炎
危险因素
腰椎穿刺
儿童
hand-food-mouth disease
aseptic meningitis
risk factor
lumber puncture
child
