基础生命体征对危重型手足口病的早期诊断价值

Clinical values and optimal cut-off points of basic vital signs in early identification of critical hand, foot, and mouth disease

摘要:

目的 探讨基础生命体征在早期识别危重型手足口病中的诊断价值。方法 收集2010 年1 月至2014 年8 月358 例重症手足口病患儿(2 期重型212 例, 3 期危重型146 例)的临床资料, 采用受试者工作特征(ROC)曲线分析峰热、热程以及不同年龄段心率(HR)、呼吸频率(RR)、收缩压(SBP)和舒张压(DBP)对诊断3 期(危重型)手足口病的价值。结果 0 岁~ 组患儿中, 当HR ≥ 148.5 次/min、RR ≥ 36.5 次/min、SBP ≥ 95 mm Hg、DBP ≥ 59 mm Hg, 提示手足口病患儿可能进展到危重型;1 岁~ 组患儿中, 当HR≥ 142.5 次/min、RR ≥ 31.5 次/min、SBP ≥ 103 mm Hg、DBP ≥ 60.5 mm Hg 时, 对诊断危重型手足口病有一定价值;≥ 3 岁组患儿中, 当HR ≥ 139 次/min、RR ≥ 29.5 次/min、SBP ≥ 103 mm Hg, 提示手足口病患儿可能进展到危重型;各指标敏感度均大于0.517, 特异度均高于0.769。手足口病患儿峰热AUC=0.507, 与AUC=0.5 比较差异无统计学意义(P=0.816);当热程≥ 5.5 d 时, 敏感度为0.589、特异度为0.571。结论 HR、RR 和BP 是早期识别危重型手足口病的良好指标, 识别的最佳临界点具有年龄特征, 峰热、热程及年长患儿DBP 对早期识别危重型手足口病的价值不大。

Abstract:

Objective To study the clinical values of basic vital signs in early identification of critical hand-footmouth disease (HFMD). Methods The clinical data of 358 children with severe HFMD [212 cases in stage 2 (central nervous system involvement) and 146 cases in stage 3 (earlier stage of cardiopulmonary failure, critical type)] were reviewed. The diagnostic values of peak temperature and duration of fever, as well as the heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in different age groups, for critical HFMD (stage 3) were analyzed using the receiver operating characteristic (ROC) curve. Results HFMD might progress to critical type in case of HR ≥148.5 beats/minutes, RR ≥36.5 times/minutes, SBP ≥95 mm Hg, and DBP ≥59 mm Hg among children aged 0-1 year. HR ≥142.5 times/minutes, RR ≥31.5 times/mintes, SBP ≥103 mm Hg, and DBP ≥60.5 mm Hg in children aged 1-2 years had a certain diagnostic value for critical HFMD. HFMD might progress to critical type in case of HR ≥139.5 times/minutes, RR ≥29.5 times/minutes, and SBP ≥103 mm Hg among children ≥3 years of age. The sensitivity and specificity of every indicator were higher than 0.517 and 0.769, respectively. The area under the ROC curve (AUC) for peak temperature was 0.507 (P=0.816, compared with AUC=0.5). When the duration of fever was ≥5.5 days, the sensitivity and specificity were 0.589 and 0.571, respectively. Conclusions HR, RR, and BP are good indicators to identify critical HFMD (stage 3) early. The optimal cut-off points conform to the age characteristics of children. DBP in children ≥3 years of age, peak temperature, and duration of fever have a low value in early identification of critical HFMD.