本文選題：手足口病 + 重癥�。� 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)研究手足口病重癥型和普通型的流行病學(xué)、臨床特征和實(shí)驗(yàn)室檢查結(jié)果,探討手足口病的發(fā)病特點(diǎn)及血液生化檢驗(yàn)重癥危險(xiǎn)因素,為手足口病重癥早期識(shí)別和干預(yù)治療提供理論依據(jù),以降低死亡率,減少后遺癥,提高治愈率。方法:選取2013年1月1日至2015年12月31日期間在河南省三門(mén)峽市中心醫(yī)院感染性疾病科收治住院的258例確診手足口病患兒的病例資料為研究對(duì)象,其中重癥型67例,普通型191例,對(duì)其流行病學(xué)、臨床特征和實(shí)驗(yàn)室檢查結(jié)果進(jìn)行回顧性分析。采用χ2檢驗(yàn)和t檢驗(yàn)比較兩組的差異,運(yùn)用Logistic回歸分析手足口病血液生化檢驗(yàn)重癥危險(xiǎn)因素。結(jié)果:1.手足口病4~7月集中發(fā)病。男女比約為1.46:1(153:105),兩組患兒性別構(gòu)成比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。1~3歲年齡組發(fā)病人數(shù)最多(66.7%,172/258),兩組患兒年齡比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。農(nóng)村患兒多于城市患兒,兩組患兒地域特征比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。散居兒童發(fā)病多于幼托兒童,兩組患兒地域分布特征比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。多數(shù)患兒無(wú)明確接觸史,兩組患兒接觸史比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.重癥組以中等度熱、高熱為主,普通組以中等度熱、低熱為主,兩組患兒入院前發(fā)熱比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),熱程比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患兒皮疹分布類(lèi)型均以手+足+臀+口部,手+足+口部,手+足部為多見(jiàn),皮疹最常累及部位依次是手、足、口腔和臀部,出現(xiàn)單一部位的皮疹以手部最常見(jiàn),其次是口、足和臀部。兩組患兒皮疹分布部位和部位數(shù)比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),入院前出疹時(shí)間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。手足口病患兒多見(jiàn)同時(shí)出現(xiàn)發(fā)熱和皮疹,兩組患兒發(fā)熱與出疹時(shí)間關(guān)系比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。67例重癥患兒均有不同程度神經(jīng)系統(tǒng)受累表現(xiàn),兩組患兒神經(jīng)系統(tǒng)受累癥狀比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患兒在咳嗽、流涕等癥狀和腹痛、腹瀉等癥狀方面比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);在食欲不振和持續(xù)高熱方面比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.兩組患兒白細(xì)胞計(jì)數(shù)、紅細(xì)胞計(jì)數(shù)、血小板計(jì)數(shù)、血紅蛋白,肝功能(ALT、AST、GGT),心肌酶譜(CK、CK-MB、LDH、α-HBDH),腎功能(Urea、CRE)、血清電解質(zhì)(Ca2+)結(jié)果比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);CRP,血糖,血清電解質(zhì)(K+、Na+、Cl-)結(jié)果比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患兒EV71-RNA檢測(cè)結(jié)果比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患兒尿酮體結(jié)果比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。本研究資料中共有85例手足口病患兒行腦脊液常規(guī)和生化檢驗(yàn),其中重癥組60例,普通組25例,兩組患兒CSF-WBC,CSF-P,潘氏實(shí)驗(yàn)結(jié)果比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);CSF-GLU、CSF-CL、ADA比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。4.Logistic回歸單因素分析結(jié)果可見(jiàn)兩組患兒血液生化檢驗(yàn)項(xiàng)目中CRP、CK、GGT、Na+差異有統(tǒng)計(jì)學(xué)意義(P0.05),多因素分析結(jié)果顯示CRP升高(OR=2.863,P0.05)、GGT降低(OR=2.040,P0.05)為手足口病重癥危險(xiǎn)因素,CK升高(OR=0.386,P0.05)為保護(hù)因素。結(jié)論:1.手足口病患兒多無(wú)明確接觸史,同時(shí)出現(xiàn)發(fā)熱和皮疹多見(jiàn);重癥患兒入院前發(fā)熱和出疹時(shí)間更長(zhǎng),發(fā)熱程度可不高,白細(xì)胞計(jì)數(shù)可無(wú)明顯增高。2.CRP升高、GGT降低為手足口病重癥危險(xiǎn)因素,CK升高為保護(hù)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.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R725.1

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