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手足口病是由肠道病毒感染引起的常见传染性疾病,主要发生在7岁以下的婴幼儿。大多数患儿病情轻微,但部分病例可合并肺炎、脑炎等严重并发症,威胁患儿生命安全[1]。肠道病毒71型感染引起的手足口病特征为脑炎等并发症发生率高,严重时可发展成脑干脑炎或神经源性肺水肿;由于临床缺乏有效的抗病毒药物,严重手足口病的治疗具有挑战性[2]。炎症因子等指标在手足口病合并脑炎患儿外周血中水平升高,并可能成为患儿治疗效果和预后的有效生物学指标[3]。水通道蛋白4在中枢神经系统中高表达,且在脑水肿发生和进展中发挥重要作用[4]。本研究旨在观察水通道蛋白4水平在手足口病并发脑炎患儿脑脊液中变化情况及其与外周血的炎症因子、神经损伤指标相关性。现作报道。
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3组入院第2天脑脊液中水通道蛋白4水平差异有统计学意义(P < 0.01),其中观察组高于单纯手足口病组和对照组(P < 0.01),单纯手足口病组和对照组差异无统计意义(P>0.05);入院第7天(恢复期),观察组较入院第2天降低,仍高于单纯手足口病组,差异有统计学意义(P < 0.01)(见表 1)。
分组 n 入院第2天 入院第7天 观察组 40 17.4±3.1**## 11.2±2.9##□□ 单纯手足口病组 40 8.2±2.2 8.0±2.3 对照组 36 7.3±1.9 — F — 200.14 5.47△ P — < 0.01 < 0.01 MS组内 — 6.105 — q检验:与对照组比较** P < 0.01;与单纯手足口病组比较## P < 0.01;组内检验:□□ P < 0.01;△示t值 表 1 3组第2天和第7天脑脊液中水通道蛋白4水平比较(x±s;ng/L)
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3组第2天外周血炎症因子水平差异有统计学意义(P < 0.01);观察组IL-1β、IL-6、IL-18、CRP、PCT、TNF-α高于单纯手足口病组及对照组,单纯手足口病组IL-1β、IL-6、IL-18、CRP、PCT、TNF-α高于对照组,差异有统计学意义(P < 0.01)(见表 2)。
分组 n IL-1β/(ng/L) IL-6/(μg/L) IL-18/(ng/L) CRP/(mg/L) PCT/(μg/L) TNF-α/(μg/L) 观察组 40 77.3±8.9**## 47.5±6.5**## 12.4±3.1**## 12.8±3.1**## 1.20±0.40**## 136.4±15.8**## 单纯手足口病组 40 48.2±7.4** 33.0±5.3** 8.5±2.4** 6.4±2.0** 0.46±0.11** 70.6±8.9** 对照组 36 17.9±3.5 14.1±2.4 5.3±1.6 3.1±0.9 0.12±0.03 29.8±5.7 F — 668.35 406.41 78.94 188.77 196.62 896.12 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 MS组内 — 50.032 20.061 6.098 4.948 0.060 123.560 q检验:与对照组比较** P < 0.01;与单纯手足口病组比较## P < 0.01 表 2 3组第2天外周血炎症因子水平比较(x±s)
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3组第2天外周血神经损伤指标水平差异有统计学意义(P < 0.01),观察组NSE、S-100B、MBP水平高于单纯手足口病组及对照组(P < 0.01),单纯手足口病组和对照组NSE、S-100B、MBP水平差异均无统计学意义(P>0.05)(见表 3)。
分组 n NSE S-100B MBP 观察组 40 19.8±3.4**## 0.76±0.20**## 0.64±0.12**## 单纯手足口病组 40 8.2±2.1 0.23±0.06 0.25±0.06 对照组 36 7.9±2.1 0.24±0.05 0.24±0.06 F — 262.81 228.55 278.77 P — < 0.01 < 0.01 < 0.01 MS组内 — 6.878 0.016 0.007 q检验:与对照组比较** P < 0.01;与单纯手足口病组比较## P < 0.01 表 3 3组第2天外周血神经损伤指标比较(x±s;μg/L)
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相关性分析显示,脑脊液中水通道蛋白4水平与外周血中炎症因子(IL-1β、IL-6、IL-18、CRP、PCT、TNF-α)及神经损伤指标(NSE、S-100B、MBP)均呈正相关关系(P < 0.05~P < 0.01)(见表 4)。
因素 r P IL-1β 0.298 < 0.05 IL-6 0.377 < 0.05 IL-18 0.310 < 0.05 CRP 0.349 < 0.05 PCT 0.290 < 0.05 TNF-α 0.427 < 0.01 NSE 0.319 < 0.05 S-100B 0.405 < 0.05 MBP 0.276 < 0.05 表 4 水通道蛋白4水平与外周血中炎症因子及神经损伤指标相关性
手足口病并发脑炎患儿水通道蛋白4水平变化及其与炎症因子、神经损伤指标相关性
Study on the correlations between the level of aquaporin 4 and inflammatory factors, nerve injury indexes in children with HFMD complicated with encephalitis
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摘要:
目的探讨手足口病并发脑炎患儿水通道蛋白4水平变化及其与炎症因子、神经损伤指标相关性。 方法选取40例手足口病神经系统受累期患儿作为观察组,选取同期收治的40例手足口病出疹期患儿作为单纯手足口病组,36例排除手足口病及脑炎等其他疾病的热性惊厥患儿作为对照组。检测脑脊液中水通道蛋白4水平及外周血中炎症因子[白细胞介素-1β(IL-1β)、IL-6、IL-18、C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)]、神经损伤指标[髓鞘碱性蛋白(MBP)、神经特异性烯醇化酶(NSE)、S-100B蛋白]水平,分析脑脊液中水通道蛋白4水平与外周血中炎症因子及神经损伤指标相关性。 结果入院第2天患儿脑脊液水平观察组高于单纯手足口病组和对照组(P < 0.01);入院第7天(恢复期),观察组脑脊液水通道蛋白4水平较入院第2天降低,仍高于单纯手足口病组(P < 0.01)。3组患儿外周血炎症因子、神经损伤指标水平差异有统计学意义(P < 0.01)。相关性分析显示,观察组第2天脑脊液水通道蛋白4与外周血中炎症因子及神经损伤指标均呈正相关关系(P < 0.05~P < 0.01)。 结论手足口病并发脑炎患儿脑脊液中水通道蛋白4水平在急性期升高,在恢复期降低,且与外周血炎症因子、神经损伤指标呈正相关。 Abstract:ObjectiveTo study the the correlations between the level of aquaporin 4 and inflammatory factors, nerve injury indexes in children with hand, foot and mouth disease(HFMD) complicated with encephalitis. MethodsForty children with HFMD complicated with nerve system involvement were set as the observation group, 40 children with rashes of HFMD were set as the simple HFMD group, and 36 febrile convulsion children without HFMD and encephalitis were set as the control group.The level of aquaporin 4 in cerebrospinal fluid, serum levels of inflammatory factors[(including the interleukin(IL)-1β, IL-6, IL-18, C reactive protein(CRP), procalcitonin(PCT) and tumor necrosis factor(TNF)-α] and nerve injury index levels[including the myelin basic protein(MBP), nerve specific enolase(NSE) and S-100B proteins] in peripheral blood were detected.The correlations between the level of aquaporin 4 and inflammatory factors, nerve injury indexes in peripheral blood were analyzed. ResultsThe level of aquaporin 4 of cerebrospinal fluid in observation group on the second day of admission was higher than that in simple HFMD group and control group(P < 0.01).The level of aquaporin 4 in observation group on the seventh day of admission was higher than that on the second day of admission, and in simple HFMD group and control group(P < 0.01).The differences of the levels of inflammatory factors and nerve injury indexes among three groups were statistically significant(P < 0.01).The results of correlation analysis showed that the level of aquaporin 4 of cerebrospinal fluid in the observation group on the second day of admission was positively correlated with the peripheral inflammatory factors and nerve injury indexes(P < 0.05 to P < 0.01). ConclusionsThe level of aquaporin 4 in children with HFMD complicated with encephalitis increases in the acute phase, decreases in the recovery phase, and is positively correlated with the inflammatory factors and nerve injury indexes. -
表 1 3组第2天和第7天脑脊液中水通道蛋白4水平比较(x±s;ng/L)
分组 n 入院第2天 入院第7天 观察组 40 17.4±3.1**## 11.2±2.9##□□ 单纯手足口病组 40 8.2±2.2 8.0±2.3 对照组 36 7.3±1.9 — F — 200.14 5.47△ P — < 0.01 < 0.01 MS组内 — 6.105 — q检验:与对照组比较** P < 0.01;与单纯手足口病组比较## P < 0.01;组内检验:□□ P < 0.01;△示t值 表 2 3组第2天外周血炎症因子水平比较(x±s)
分组 n IL-1β/(ng/L) IL-6/(μg/L) IL-18/(ng/L) CRP/(mg/L) PCT/(μg/L) TNF-α/(μg/L) 观察组 40 77.3±8.9**## 47.5±6.5**## 12.4±3.1**## 12.8±3.1**## 1.20±0.40**## 136.4±15.8**## 单纯手足口病组 40 48.2±7.4** 33.0±5.3** 8.5±2.4** 6.4±2.0** 0.46±0.11** 70.6±8.9** 对照组 36 17.9±3.5 14.1±2.4 5.3±1.6 3.1±0.9 0.12±0.03 29.8±5.7 F — 668.35 406.41 78.94 188.77 196.62 896.12 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 MS组内 — 50.032 20.061 6.098 4.948 0.060 123.560 q检验:与对照组比较** P < 0.01;与单纯手足口病组比较## P < 0.01 表 3 3组第2天外周血神经损伤指标比较(x±s;μg/L)
分组 n NSE S-100B MBP 观察组 40 19.8±3.4**## 0.76±0.20**## 0.64±0.12**## 单纯手足口病组 40 8.2±2.1 0.23±0.06 0.25±0.06 对照组 36 7.9±2.1 0.24±0.05 0.24±0.06 F — 262.81 228.55 278.77 P — < 0.01 < 0.01 < 0.01 MS组内 — 6.878 0.016 0.007 q检验:与对照组比较** P < 0.01;与单纯手足口病组比较## P < 0.01 表 4 水通道蛋白4水平与外周血中炎症因子及神经损伤指标相关性
因素 r P IL-1β 0.298 < 0.05 IL-6 0.377 < 0.05 IL-18 0.310 < 0.05 CRP 0.349 < 0.05 PCT 0.290 < 0.05 TNF-α 0.427 < 0.01 NSE 0.319 < 0.05 S-100B 0.405 < 0.05 MBP 0.276 < 0.05 -
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