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

摘要： 目的　探讨重型手足口病（HFMD）发展为危重型HFMD的影响因素，建立危重型HFMD风险评分系统，为早期识别HFMD病情严重程度提供依据。方法　以2014年郑州大学附属儿童医院收治的157例重症HFMD患儿为研究对象，其中重型94例，危重型63例。比较两组患儿的一般情况、临床表现、实验室检查等指标，采用多因素Logistic回归分析危重型HFMD的影响因素，制定危重型HFMD风险评分系统，采用受试者工作特征（ROC）曲线确定该风险评分系统的最佳截断点。结果　危重型患儿确诊重症前病程、确诊重症前发热时间长于重型患儿，中枢神经系统症状与出疹间隔短于重型患儿，差异有统计学意义（P<0.05）。危重型患儿频繁惊颤抖动、末梢循环不良、心率增快、频繁双吸气或长叹气患儿所占比例及热峰体温高于重型患儿，持续高热时间长于重型患儿，血压异常患儿所占比例低于重型患儿，差异有统计学意义（P<0.05）。危重型患儿空腹血糖、S100蛋白、神经特异烯醇化酶（NSE）、乳酸脱氢酶（LDH）、N末端脑钠肽前体（NT-proBNP）高于重型患儿，差异有统计学意义（P<0.01）。多因素Logistic回归分析结果显示，患儿频繁惊颤抖动、末梢循环不良、心率增快、频繁双吸气或长叹气、持续高热时间、空腹血糖、S100蛋白、NSE、NT-proBNP是重型HFMD病情进展为危重型的影响因素（P<0.05）。对风险评分系统预测重症HFMD中发生危重型的风险进行ROC曲线分析，ROC曲线下面积为0.851〔95%CI（0.788，0.936）〕。最佳截断点为13分，对应的灵敏度和特异度分别为85.71%和85.11%。结论　患儿频繁惊颤抖动、末梢循环不良、心率增快、频繁双吸气或长叹气、持续高热时间、空腹血糖、S100蛋白、NSE、NT-proBNP是重型HFMD病情进展为危重型的影响因素，危重型HFMD风险评分系统可用于评估重症HFMD病情严重程度，分值为13分可作为区分重型与危重型的最佳截断点。

关键词: 手足口病, 影响因素分析, 风险评分系统