Clinical characteristics and risk factors analysis of children with varying degrees of hand,foot and mouth disease
Objective To summarize the clinical characteristics and laboratory indicators of children with differ-ent degrees of hand,foot,and mouth disease (HFMD),analyze the risk factors for developing critical HFMD,and provide clues for clinicians to identify critical HFMD.Methods A retrospective analysis was conducted on 60 pediatric patients with HFMD treated in pediatric department of Affiliated of Zunyi Medical University.According to disease severity,they were divided into 22 cases of critical HFMD (cHFMD),20 cases of severe HFMD (sHFMD)and 18 cases of general HFMD (gHFMD).General clinical information,serum ferritin (SF),inter-leukin (IL)-6,IL-17,tumor necrosis factor-α(TNF-α)of the patients was collected.The differences in clini-cal characteristics and laboratory indicators among the three groups of patients were compared,and ROC curves were used to determine the cutoff values of non normal indicators.Logistic regression analysis was used to identi-fy independent risk factors for the occurrence of critical HFMD.Results A total of 60 children with HFMD were included in this study,including 41 males and 19 females,with an average age of (21.83±13.36,18.60±6.91,16.55±8.24)months for the gHFMD,sHFMD,and cHFMD group,respectively.Compared with the gHFMD group,patients in the sHFMD and cHFMD groups had longer duration of fever,higher incidence of star-tle or tremor,listlessness or drowsiness,the levels of SF and IL-17 were increased (P<0.05).Only patients in cHFMD group complicated with respiratory failure,neurogenic pulmonary edema,circulatory failure,and neuro-logical sequelae,accounting for 54.5％(12/22),72.7％(16/22),100％(22/22),9.1％(2/22),respec-tively.The levels of IL-6 and TNF-α,the positive rates of enterovirus 71 (EV71)were increased sequentially in the gHFMD,sHFMD,and cHFMD group (P<0.05).The levels of SF,IL-6,IL-17,and TNF-αin patients with sHFMD and cHFMD during the recovery period were significantly lower than those in the acute period (P<0.05).The application of ROC curve analysis showed that the optimal cutoff values for SF,IL-6,IL-17,and TNF-a were 381.15,787.4,806.25,481.55 ng/L,respectively.The multiple logistic regression analysis showed that EV-71 positivity,ferritin>381.15 ng/L,IL-6>787.4 ng/L are risk factors for the occurrence of critical HFMD.Conclusion Children with HFMD mainly present with fever and rash,and critically ill patients often have persistent fever,startle,listlessness,pulmonary edema,and respiratory and circulatory failure.Once patients with HFMD show ferritin>381.15 ng/L,IL-6>787.4 ng/L,and EV71 positivity,they should be alert to the occurrence of critical cases.
万方数据
维普
