探讨儿童早期预警评分联合C-反应蛋白（CRP）和降钙素原（PCT）动态监测对小儿手足口病（HFMD）分流诊断及应用价值。

收集陕西省汉中市人民医院儿科2015年3月至2019年4月确诊的共102例HFMD患儿资料，根据患儿病情严重程度分为普通病例组（58例）和重型病例组（44例）。另外选取同期于本院体检的60例健康儿童为正常组。普通病例组和重型病例组患儿均行CRP和PCT水平及中性细胞比率、淋巴细胞检测；入组时、治疗3 d和7 d以上指标的整体比较采用重复测量方差分析，组间两两比较采用LSD-t检验。

各组研究对象年龄、病程、并发症及其发生率差异均无统计学意义（P均> 0.05），但重型病例组并发症总发生率（40.90%）高于普通病例组（24.14%），差异有统计学意义（χ² = 1.685、P = 0. 045）。入组时重型病例组HFMD患儿PEWS评分各项指标均显著高于普通病例组，差异有统计学意义（P均< 0.05）。入组时各组研究对象血清CRP和PCT水平差异均有统计学意义（F = 111.079、122.299，P均< 0.001）。组间两两比较显示，重型病例组患儿血清CRP、PCT水平均显著高于正常组和普通病例组，差异均有显著统计学意义（P均< 0.05）。普通病例组和重型病例组患儿PCT、CRP、中性粒细胞百分比、淋巴细胞百分比组内（时间维度）差异均有显著统计学意义（P均< 0.05），两组组间以上指标差异均具有统计学意义（P均< 0.05）。普通病例组和重型病例组患儿PCT、CRP、中性粒细胞百分比、淋巴细胞百分比经治疗后均发生显著改变，治疗后（7 d）和入组时各指标差异均有显著统计学意义（P均< 0.05）；其中各时间点患儿PCT、CRP和中性粒细胞百分比的组间差异均有统计学意义（P均< 0.05）。时间对组别的交互作用分析提示随着发病时间的延长，PCT水平（F = 16.403、P < 0.001）和淋巴细胞百分比（F = 4.296、P = 0.040）逐渐呈显著下降趋势。

患儿血清CRP和PCT联合儿童早期预警评分对于小儿手足口病的临床诊治有重要意义，血清CRP和PCT在短时间内升高应立即进行更深入地诊治，以防病情恶化。

To investigate the application value of early childhood warning combined with dynamic monitoring of C-reactive protein (CRP) and procalcitonin (PCT) in shunt diagnosis of children with hand, foot and mouth disease (HFMD).

From March 2015 to April 2019, a total of 102 children diagnosed as HFMD in Department of Pediatrics of Hanzhong People’s Hospital of Shaanxi Province were divided into ordinary group (58 cases) and severe group (44 cases) according to the severity condition; While 60 healthy children from physical examination center of the hospital were selected as control group. The levels of CRP, PCT, neutrophil ratio and lymphocyte percentage were detected of children in ordinary group and severe group. Overall comparison of the above indicators at admission, the 3rd day and 7th day after treatment were analyzed by repeated measures ANOVA, while comparison between every two groups were analyzed by LSD-t test.

There were no significant differences in age, course of disease, distribution and incidence of complications among cases of three groups (all P > 0.05), but the total incidence of complications of cases in severe group (40.90%) was significantly higher than that of the ordinary group (24.14%), with significant difference (χ² = 1.685, P = 0.045). PEWS scores were performed on all 102 children with HFMD at the time of enrollment, which were significantly higher in severe group than those of ordinary group, with significance differences (all P < 0.05). The levels of serum CRP and PCT among all three groups at the time of enrollment were significantly different (F = 111.079, 122.299; both P < 0.001). Pairwise comparison showed that serum levels of CRP and PCT of cases in severe group were significantly higher than those of ordinary group and control group, with significant differences (all P < 0.05). There were significant differences of PCT, CRP, neutrophil percentage and lymphocyte percentage in severe group and ordinary group by intra-group comparison (time dimension) (all P < 0.05), and the above indexes between severe group and ordinary group were significantly different (all P < 0.05). The levels of PCT, CRP, neutrophil percentage and lymphocyte percentage of cases in ordinary group and severe group were all significantly changed after treatment; the levels of the above indexes after treatment (7 d) were all with significant differences compared with those of admission into the group (all P < 0.05). There were significant differences of PCT, CRP levels and neutrophils percentage between ordinary group and severe group at each time point (all P < 0.05). The interaction analysis of time on groups showed that PCT level (F = 16.403, P < 0.001) and lymphocyte percentage (F = 4.296, P = 0.040) gradually decreased with the disease progression.

The detection of children’s serum CRP and PCT combined with early childhood warning scores had significant significance on clinical diagnosis and treatment of pediatric HFMD, which was helpful for clinicians to evaluate the severity of the disease. When serum CRP and PCT levels increased in a short time, in-depth observation and prevention should be carried out immediately to avoid further deterioration.