Analysis Of Clinical Features And Risk Factors On Children With Severe Hand,Foot And Mouth Disease

Objective: Collect the clinical data of children with different types of hand,foot and mouth disease(HFMD),and analysis on differences in clinical features and risk factors of children with different types of HFMD.The goal of research is to early diagnosis,further recognize severe HFMD or critical severe HFMD,and provide reliable scientific basis for the treatment of HFMD.Methods: The research object were 110 clinical data of children with hand,foot and mouth disease who were hospitalized in Hainan maternal and Child Health Hospital(Hainan children's Hospital)from January 2014 to December 2015.According to The Guide for the Diagnosis and Treatment of Hand,Foot and Mouth Disease established by The Ministry of Health issued in 2010,HFMD can divided into mild and severe,and the type of severe HFMD can divided into severe severe and critical severe.According to the purpose of the study,the patients were divided into mild group(44 cases)and severe group(66 cases).severe group(66 cases)were divided into severe severe group(44 cases)and critical severe group(22 cases).Chi square test or T test was used to compare the difference between the mild group and the severe group,and the difference between severe severe group and critical severe group.Then the high risk factors of severe and critical severe were analyed by use univariate and multivariate unconditional Logistic regression.Results:(1)Comparison in general situation,clinical symptoms and physical examination:Severe group in EV71 infection,onset to admission time,hospitalization time,total duration of disease,fever time,fever peak,startle,limb tremble,vomiting,convulsions,limb weakness,neck resistance,knee reflex abnormalities,consciousness change,breathing increased,heart rate increased,systolic pressure increased,diastolic pressure increased was higher than mild group.Critical severe group in EV71 infection,onset to admission time,hospitalization time,total duration of disease,fever time,fever peak,frequent startle,frequent vomiting,convulsions,limb weakness,consciousness change,breathing faster,heart rate increased,systolic pressure increased,diastolic pressure increased was higher than severe severe group.(2)Comparison in the auxiliary examination:Severe group in NSE,peripheral white blood cell count,peripheral neutrophil count was higher than mild group.Critical severe group in NSE,chest radiograph exudation,cerebrospinal fluid protein,procalcitonin,C-reactive protein,peripheral white blood cell count,peripheral neutrophil count was higher than severe severe group.(3)Analysis on mild HFMD progress into severe by multivariate unconditional Logistic regression display:breathing increased,onset to admission time,fever peak,peripheral neutrophil count,NSE were the five risk factors which cause mild HFMD progress into severe.Analysis on severe severe HFMD progress into critical severe by multivariate unconditional Logistic regression display:chest radiograph exudation,frequent vomiting,fever time were the three risk factors which cause severe severe HFMD progress into critical severe.Conclusions:(1)The pathogens of children with severe hand,foot and mouth disease are mainly infected with EV71,and the fever time and fever peak have a certain reference value in assessing the condition of hand,foot and mouth disease.Close observation of HFMD startle,limb tremble,vomiting,knee reflex,convulsions,limb weakness,consciousness change,breathing,heart rate,blood pressure and other symptoms and signs can help in the early detection of severe and critical severe HFMD.(2)NSE can be used as an index to evaluate the severity of HFMD,peripheral white blood cell count,peripheral neutrophil count,procalcitonin,C reactive protein is helpful for the early identification of severe HFMD.(3)Breathing increased,onset to admission time,fever peak,peripheral neutrophil count,NSE were the five risk factors which cause mild HFMD progress into severe.Chest radiograph exudation,frequent vomiting,fever time were the three risk factors which cause severe severe HFMD progress into critical severe.