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目的:应用单因素及多因素Logistic回归模型、受试者工作特征曲线(ROC曲线)探讨重症手足口病(HFMD)的危险因素,评估其预测价值,为重症HFMD的早期识别和早期治疗提供依据。方法:随机选取102例HFMD患儿进行回顾性分析,其中普通病例46例归入普通组,重症病例54例及危重病例2例归入重症组。单因素分析两组临床表现、体征、实验室检查结果的差异,多因素Logistic回归分析引起重症HFMD的独立危险因素,并应用ROC曲线评价其预测价值。结果:两组在体温、热程、精神状态、嗜睡、易惊、肢体抖动、呕吐、呼吸频率、心率、空腹血糖等方面的差异有统计学意义(P<0.05)。将上述因素进行二分类多因素Logistic回归分析,结果显示,易惊、肢体抖动、心率增快为重症HFMD的独立危险因素。3项危险因素对重症HFMD预测有更好的准确性,优于单一危险因素的诊断价值。结论:出现易惊、肢体抖动、心率增快症状的患儿应高度警惕重症HFMD的可能,并尽早进行干预。
Objective: To investigate the risk factors of severe hand-foot-and-mouth disease (HFMD) using single factor and multivariate Logistic regression models and receiver operating characteristic curve (ROC curve) to assess the predictive value of HFMD and to provide evidence for the early identification and early treatment of HFMD . Methods: A total of 102 children with HFMD were selected for retrospective analysis. Among them, 46 cases were classified as general group, 54 cases were severe cases and 2 cases were classified as severe cases. Univariate analysis of clinical manifestations, signs, laboratory test results differences, multivariate Logistic regression analysis of independent risk factors for severe HFMD, and the use of ROC curve to evaluate its predictive value. Results: There were significant differences in body temperature, heat stroke, mental state, lethargy, easy to shock, limb jitter, vomit, respiration rate, heart rate and fasting blood glucose between the two groups (P <0.05). Logistic regression analysis of the above factors by binary classification, the results showed that easy to shock, limb jitter, heart rate is an independent risk factor for severe HFMD. Three risk factors for the prediction of severe HFMD have better accuracy, superior to the diagnostic value of a single risk factor. CONCLUSIONS: Children with easy-onset, jittery limbs and fast heart rate should be highly alert to the possibility of severe HFMD and intervene as soon as possible.