Du Xing-Yuan, Li Ying, Deng Kun, Wen Shu-Mei, Lan Ling-Li, Hou Guo-Zhen, Zhang Bao-Ming
Department of Pediatrics, Guilin People's Hospital, Guilin, Guangxi 541002, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2015 Jun;17(6):602-6.
To study the clinical values of basic vital signs in early identification of critical hand-foot-mouth disease (HFMD).
The clinical data of 358 children with severe HFMD [212 cases in stage 2 (central nervous system involvement) and 146 cases in stage 3 (earlier stage of cardiopulmonary failure, critical type)] were reviewed. The diagnostic values of peak temperature and duration of fever, as well as the heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in different age groups, for critical HFMD (stage 3) were analyzed using the receiver operating characteristic (ROC) curve.
HFMD might progress to critical type in case of HR≥148.5 beats/minutes, RR≥36.5 times/minutes, SBP≥95 mm Hg, and DBP≥59 mm Hg among children aged 0-1 year. HR≥142.5 times/minutes, RR≥31.5 times/mintes, SBP≥103 mm Hg, and DBP≥60.5 mm Hg in children aged 1-2 years had a certain diagnostic value for critical HFMD. HFMD might progress to critical type in case of HR≥139.5 times/minutes, RR≥29.5 times/minutes, and SBP≥103 mm Hg among children≥3 years of age. The sensitivity and specificity of every indicator were higher than 0.517 and 0.769, respectively. The area under the ROC curve (AUC) for peak temperature was 0.507 (P=0.816, compared with AUC=0.5). When the duration of fever was ≥5.5 days, the sensitivity and specificity were 0.589 and 0.571, respectively.
HR, RR, and BP are good indicators to identify critical HFMD (stage 3) early. The optimal cut-off points conform to the age characteristics of children. DBP in children≥3 years of age, peak temperature, and duration of fever have a low value in early identification of critical HFMD.
探讨基本生命体征在早期识别重症手足口病（HFMD）中的临床价值。
回顾性分析358例重症手足口病患儿的临床资料[其中2期（累及中枢神经系统）212例，3期（心肺功能衰竭前期，危重型）146例]。采用受试者工作特征（ROC）曲线分析不同年龄组的最高体温、发热持续时间以及心率（HR）、呼吸频率（RR）、收缩压（SBP）和舒张压（DBP）对重症手足口病（3期）的诊断价值。
0～1岁儿童中，当HR≥148.5次/分钟、RR≥36.5次/分钟、SBP≥95mmHg、DBP≥59mmHg时，手足口病可能进展为危重型。1～2岁儿童中，HR≥142.5次/分钟、RR≥31.5次/分钟、SBP≥103mmHg、DBP≥60.5mmHg对重症手足口病有一定的诊断价值。3岁及以上儿童中，当HR≥139.5次/分钟、RR≥29.5次/分钟、SBP≥103mmHg时，手足口病可能进展为危重型。各指标的敏感性和特异性分别高于0.517和0.769。最高体温的ROC曲线下面积（AUC）为0.507（与AUC=0.5比较，P=0.816）。当发热持续时间≥5.
