关键词: 手足口病, 影响因素分析, 风险评分系统

Abstract: Objective　To explore the factors influencing the progression of severe hand，foot，and mouth disease（HFMD） to critical and severe HFMD，and construct a risk scoring system for critical and severe HFMD to provide a reference for the early assessment of HFMD severity.Methods　The study subjects included 157 HFMD patients（94 severe and 63 critical patients）．The general information，clinical manifestations，and laboratory tests between the two groups were compared.Multivariate Logistic regression analysis was used to analyze the factors influencing critical HFMD.A risk scoring system was constructed for predicting critical HFMD.A ROC curve was used to determine the best cut-off point of the risk scoring system.Results　The duration of disease course and fever before diagnosis in the critical HFMD children was significantly longer than the severe HFMD children（P<0.05）．The proportion of children with frequent tremors，poor peripheral circulation，increased heart rate，frequent double inhalations or long sighs，and abnormal blood pressure among the critical children was significantly higher than the severe children（P<0.05）．The fasting blood glucose，S100 protein，nerve-specific enolase（NSE），lactate dehydrogenase（LDH），and N-terminal pro-brain natriuretic peptide（NT-proBNP） among the critical children were also higher than the severe children（P<0.01）．Multivariate Logistic regression analysis showed that frequent tremors，poor peripheral circulation，rapid heart rate，frequent double inhalations or long sighs，persistent high fever，and high levels of fasting blood glucose，S100 protein，NSE，and NT-proBNP influenced the development of critical HFMD（P<0.05）．ROC analysis showed the AUC of the risk scoring system for predicting critical HFMD was 0.851〔95%CI（0.788，0.936）〕，and the best cut-off value was 13，corresponding to an 85.71% sensitivity and 85.11% specificity.Conclusion　Frequent tremors，poor peripheral circulation，rapid heart rate，frequent double inhalations or long sighs，persistent high fever，and high levels of fasting blood glucose，S100 protein，NSE，and NT-proBNP influenced the progression of severe HFMD to critical HFMD.The constructed risk scoring system can be used to assess HFMD severity.The best cut-off value to differentiate severe and critical HFMD is 13 points.

Key words: Hand, foot and mouth disease；Root cause analysis；Risk scoring system