摘要
目的建立一个儿童手足口病(HFMD)的临床诊断评分系统,并评价其准确度。方法回顾性分析2012年1月至2017年12月在首都儿科研究所附属儿童医院感染科就诊的1 435例年龄≤3岁的急性出疹性疾病患儿的临床资料,根据肠道病毒核酸检测结果,分为HFMD组1 094例和非HFMD组341例。随机选取70%作为训练集(1 004例),其余30%作为测试集(431例),采用多元Logistic回归筛选临床变量并建立手足口病临床诊断评分系统,同时在测试集中进行评分系统的验证及评价。结果 HFMD组病程、年龄、暴露史阳性占比均显著大于非HFMD组(χ^(2)/t值分别为3.36、4.44、97.88,P<0.01),两组性别构成比差异无统计学意义(P>0.05);HFMD组在硬腭、软腭、舌、颊粘膜、牙龈、前胸、后背、臀部和足趾的皮疹分布数量较非HFMD组更多(χ^(2)值分别为61.77、48.25、20.79、41.32、7.73、27.53、30.34、44.23、29.27,P<0.05);HFMD组发热的比例以及白细胞计数和中性粒细胞占比均高于非HFMD组(χ^(2)/t值分别为13.49、5.21、10.17,P<0.05);利用训练集数据共筛选出7项纳入多因素评分预测模型,包括年龄、暴露史、3个口腔溃疡部位(硬腭、软腭、颊粘膜)和2个躯体皮疹部位(背部、臀部),该评分系统受试者工作特征(ROC)曲线下面积为0.80(95%CI:0.77~0.84,P<0.01),敏感度为0.76,特异度为0.68;评分系统在测试集中ROC曲线下面积为0.76(95%CI:0.71~0.81,P<0.01),敏感度为0.76,特异度为0.62。结论该评分系统敏感度、特异度及准确性较好,可作为一种儿童手足口病快速、低成本的辅助诊断方法。
Objective To construct a clinical diagnostic scoring system for hand-foot-and-mouth disease(HFMD) in children, and evaluate its accuracy. Methods A retrospective analysis was performed in the clinical data of 1 435 children, who were ≤3 years old, with acute rash diseases, and admitted into the Department of Infectious Diseases, Affiliated Children′s Hospital, Capital Institute of Pediatrics. They were divided into the HFMD group with 1094 cases and non-HFMD group with 341 cases based on the results of enterovirus nucleic acid detection. 70% of the children were randomly selected as the training set(1 004 cases),and 30% of the children were the test set(431 cases). Multivariate Logistic regression was performed to identify clinical variables and construct a clinical diagnostic scoring system for hand-foot-and-mouth disease. Meanwhile, validation and evaluation of the scoring system were adopted in the test set. Results The course of disease, age and proportion of positive exposure history of the HFMD group were significantly higher than those of the non-HFMD group(χ^(2)/t=3.36,4.44 and 97.88,respectively, P<0.01),and there was no statistically significant difference in the composition of sex between the two groups(P>0.05). The distribution numbers of skin rash in hard palate, soft palate, tongue, buccal mucosa, gingiva, anterior chest, back, buttock and foot and toes in the HFMD group were significantly higher than those of the non-HFMD group(χ^(2)=61.77,48.25,20.79,41.32,7.73,27.53,30.34,44.23 and 29.27,respectively, P<0.05). The proportion of fever, white blood cell count and neutrophils percentage in the HFMD group were higher than those in the non-HFMD group(χ^(2)/t=13.49,5.21 and 10.17,respectively, P<0.05). Using data of the training set, 7 clinical variables were selected to be included in the scoring predictive system, containing age, exposure history, 3 regions of mouth ulcers(hard palate, soft palate and buccal mucosa) and 2 regions of body rash(back and buttock),and the area under the receiver operating characteristic(ROC) curve for the scoring system was 0.80(95%CI:0.77~0.84,P<0.01),with a sensitivity of 0.76 and a specificity of 0.68. In the test set, the area under the ROC curve for the scoring system was 0.76(95%CI:0.71~0.81,P<0.01),with a sensitivity of 0.76 and specificity of 0.62. Conclusion The scoring system has good sensitivity, specificity and accuracy, and can be used as a rapid and low-cost auxiliary diagnostic method for hand-foot-and-mouth disease in children.
作者
黄辉
邓莉
贾立平
朱汝南
HUANG Hui;DENG Li;JIA Liping;ZHU Runan(Department of Infectious Diseases,Affiliated Children′s Hospital,Capital Institute of Pediatrics,Beijing 100021,China;Laboratory of Virology,Affiliated Children′s Hospital,Capital Institute of Pediatrics,Beijing 100021,China)
出处
《中国妇幼健康研究》
2021年第8期1187-1194,共8页
Chinese Journal of Woman and Child Health Research
基金
北京市医院管理中心儿科学科协同发展中心专项经费资助(XTCX201822)
首都儿科研究所所级基金资助(PY-2018-05)。
关键词
儿童
手足口病
肠道病毒
临床诊断
评分系统
受试者工作特征曲线
children
hand-foot-and-mouth disease
enterovirus
clinical diagnosis
scoring system
receiver operating characteristic curve
作者简介
黄辉(1981-),女,副主任医师,主要从事儿童感染性疾病研究;通讯作者:邓莉,主任医师。
