手足口病伴发热性惊厥患儿的临床特点及影响因素分析
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摘要
目的分析手足口病(hand foot and mouth disease, HFMD)伴发热性惊厥(febrile seizures, FS)的临床特点,研究HFMD伴发FS的影响因素。方法回顾性分析2018年6～9月首都医科大学附属北京佑安医院收治的184例HFMD患儿的临床资料,排除3例既往存在热性惊厥和癫痫史的患儿,共入选181例,其中男123例,女58例,根据是否伴发FS分为惊厥组(117例)和非惊厥组(64例),描述HFMD伴发FS患儿的临床特点,比较两组间年龄、性别、实验室指标的差异,对HFMD伴发FS进行单因素及多因素分析。结果单因素分析显示,两组年龄、血糖、血钠、血氯水平差异均有统计学意义(P<0.05),惊厥组年龄显著低于非惊厥组[(1.3±0.9)岁、(2.6±1.9)岁,P=0.000],血糖高于非惊厥组[(5.9±1.3)mmol/L、(4.7±0.9)mmol/L,P=0.000],血钠低于非惊厥组[(135.1±2.3)mmol/L、(138.1±2.1)mmol/L,P=0.000];多因素分析显示,年龄、高糖血症、低钠血症是HFMD伴发FS的独立危险因素,OR值分别为1.313(95%CI:1.003～1.718)、0.474(95%CI:0.328～0.683)、1.706(95%CI:1.361～2.137),P均<0.05。结论对于低钠血症、高糖血症、年龄较小的HFMD患儿,应警惕FS的发生,及时给予对症处理。
Objective To analyze the clinical characteristics and the influence factors of hand, foot and mouth disease(HFMD) with febrile seizures(FS). Methods A retrospective analysis was made of the clinical data of 184 children with HFMD admitted to Beijing Youan Hospital from June to September 2018. Three cases of FS and epilepsy were excluded. One hundred and eighty-one children were enrolled, including 123 males and 58 females. The patients were divided into two groups according to whether they had FS or not. The clinical characteristics of children with FS were described. The differences of age, gender and laboratory test indices between the two groups were compared, and the single and multiple factors influencing FS in children were analyzed. Results A total of 117 children in seizures group and 64 children in non-seizures group were collected. The univariate analysis showed that age, blood sugar, blood sodium and blood chlorine levels were significantly different between the two groups(all P<0.05). Age in seizures group was significantly lower than that in non-seizures group [(1.3 ± 0.9) years vs.(2.6 ± 1.9) years, P<0.05], blood sugar was higher than that in non-seizures group [(5.9 ± 1.3)mmol/L vs.(4.7±0.9) mmol/L, P<0.05] and blood sodium was lower than that in non-seizures group [(135.1±2.3) mmol/L vs.(138.1 ± 2.1) mmol/L, P<0.05]. Multivariate analysis showed that age, hyperglycemia and hyponatremia were independent risk factors for FS associated with HFMD, and their OR values were 1.313(95% CI:1.003-1.718), 0.474(95% CI:0.328-0.683), 1.706(95% CI:1.361-2.137) respectively(P<0.05). Conclusions For children of HFMD with hyponatremia, hyperglycemia and younger age, we should be alert to the occurrence of FS and give timely symptomatic treatment.
Objective To analyze the clinical characteristics and the influence factors of hand, foot and mouth disease(HFMD) with febrile seizures(FS). Methods A retrospective analysis was made of the clinical data of 184 children with HFMD admitted to Beijing Youan Hospital from June to September 2018. Three cases of FS and epilepsy were excluded. One hundred and eighty-one children were enrolled, including 123 males and 58 females. The patients were divided into two groups according to whether they had FS or not. The clinical characteristics of children with FS were described. The differences of age, gender and laboratory test indices between the two groups were compared, and the single and multiple factors influencing FS in children were analyzed. Results A total of 117 children in seizures group and 64 children in non-seizures group were collected. The univariate analysis showed that age, blood sugar, blood sodium and blood chlorine levels were significantly different between the two groups(all P<0.05). Age in seizures group was significantly lower than that in non-seizures group [(1.3 ± 0.9) years vs.(2.6 ± 1.9) years, P<0.05], blood sugar was higher than that in non-seizures group [(5.9 ± 1.3)mmol/L vs.(4.7±0.9) mmol/L, P<0.05] and blood sodium was lower than that in non-seizures group [(135.1±2.3) mmol/L vs.(138.1 ± 2.1) mmol/L, P<0.05]. Multivariate analysis showed that age, hyperglycemia and hyponatremia were independent risk factors for FS associated with HFMD, and their OR values were 1.313(95% CI:1.003-1.718), 0.474(95% CI:0.328-0.683), 1.706(95% CI:1.361-2.137) respectively(P<0.05). Conclusions For children of HFMD with hyponatremia, hyperglycemia and younger age, we should be alert to the occurrence of FS and give timely symptomatic treatment.
引文
[1]中华人民共和国国家卫生健康委员会.手足口病诊疗指南(2018年版)[J].中华临床感染病杂志,2018,11:161-166.
[2]中华医学会儿科学分会神经学组.热性惊厥诊断治疗与管理专家共识(2017实用版)[J].中华实用儿科临床杂志,2017,32:1379-1382.
[3]许华山,陈凤英,吴俊峰,等.肠道病毒不同亚型与手足口病并发热性惊厥相关性的病例对照研究[J].实用药物与临床,2017,20:1294-1296.
[4]王屹,景淑军,王大利,等.手足口病合并热性惊厥的临床特点与病原学分析[J].中国现代医药杂志,2017,19:49-50.
[5]Gupta A.Febrile Seizures[J].Continuum(Minneap Minn),2016,22:51-59.
[6]张静.2008-2017年中国手足口病流行趋势和病原变化动态数列分析[J].中华流行病学杂志,2019,40:147-154.
[7]郑伟华,李雄,欧维琳,等.通用型肠道病毒感染重症手足口病临床病理特点分析[J].广西医学,2017,39:772-775.
[8]朱伟金,梁会营,叶家卫,等.手足口病伴发惊厥患儿临床特征及相关因素[J].中华传染病杂志,2016,34:565-567.
[9]王燕梅,赵彦沙,杨银升,等.婴儿热性惊厥复发因素研究[J].中国药物与临床,2019,19:108-109.
[10]杨雄华.高热惊厥患儿血钠水平临床观察分析[J].深圳中西医结合杂志,2018,28:174-175.
[11]陆桂宁,林春旺,黄国淳.小儿单纯热性惊厥再发与血钠水平的相关性分析[J].中国医药指南,2013,11:135-136.
[12]李琴娜,图雅.儿童热性惊厥与血清离子及微量元素的相关性分析[J].现代医学与健康研究电子杂志,2018,2:139-140.
[13]赵艳芳,杨晓雯,陈述英.热性惊厥与血电解质关系的研究进展[J].泰山医学院学报,2017,38:478-480.
[14]周彬,李立达.小儿高热惊厥236例临床分析[J].徐州医学院学报,2009,29:668-671.
[15]王荃,钱素云.加强对重型和危重型手足口病例的早期识别[J].北京医学,2018,40:612-613.
[16]黄填,叶志雄,曾晓聪.热性惊厥患儿血清电解质与血糖变化的研究[J].中外医学研究,2018,16:11-12.
[2]中华医学会儿科学分会神经学组.热性惊厥诊断治疗与管理专家共识(2017实用版)[J].中华实用儿科临床杂志,2017,32:1379-1382.
[3]许华山,陈凤英,吴俊峰,等.肠道病毒不同亚型与手足口病并发热性惊厥相关性的病例对照研究[J].实用药物与临床,2017,20:1294-1296.
[4]王屹,景淑军,王大利,等.手足口病合并热性惊厥的临床特点与病原学分析[J].中国现代医药杂志,2017,19:49-50.
[5]Gupta A.Febrile Seizures[J].Continuum(Minneap Minn),2016,22:51-59.
[6]张静.2008-2017年中国手足口病流行趋势和病原变化动态数列分析[J].中华流行病学杂志,2019,40:147-154.
[7]郑伟华,李雄,欧维琳,等.通用型肠道病毒感染重症手足口病临床病理特点分析[J].广西医学,2017,39:772-775.
[8]朱伟金,梁会营,叶家卫,等.手足口病伴发惊厥患儿临床特征及相关因素[J].中华传染病杂志,2016,34:565-567.
[9]王燕梅,赵彦沙,杨银升,等.婴儿热性惊厥复发因素研究[J].中国药物与临床,2019,19:108-109.
[10]杨雄华.高热惊厥患儿血钠水平临床观察分析[J].深圳中西医结合杂志,2018,28:174-175.
[11]陆桂宁,林春旺,黄国淳.小儿单纯热性惊厥再发与血钠水平的相关性分析[J].中国医药指南,2013,11:135-136.
[12]李琴娜,图雅.儿童热性惊厥与血清离子及微量元素的相关性分析[J].现代医学与健康研究电子杂志,2018,2:139-140.
[13]赵艳芳,杨晓雯,陈述英.热性惊厥与血电解质关系的研究进展[J].泰山医学院学报,2017,38:478-480.
[14]周彬,李立达.小儿高热惊厥236例临床分析[J].徐州医学院学报,2009,29:668-671.
[15]王荃,钱素云.加强对重型和危重型手足口病例的早期识别[J].北京医学,2018,40:612-613.
[16]黄填,叶志雄,曾晓聪.热性惊厥患儿血清电解质与血糖变化的研究[J].中外医学研究,2018,16:11-12.