摘要
目的探讨实验室指标在手足口病重症病例诊断中的意义,从检验医学角度分析重症手足口病的发病实质。方法选择50例重症手足口病患儿为病例组,另选同期50例轻症手足口病患儿为对照组,于入院次日晨采集空腹全血样本同时检测白细胞(WBC)、红细胞(RBC)、血小板(PLT)、中性细胞比率(NEUT%)、淋巴细胞比率(LYMPH%)、单核细胞比率(MONO%)、C反应蛋白(CRP)、T细胞(CD3+)、Ts细胞(CD3+CD8+)、Th细胞(CD3+CD4+)、Th/Ts(CD4/CD8)、NK细胞(CD16+CD56+)、B细胞(CD19+)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、补体C3(C3)、补体C4(C4)、红细胞沉降率(ESR)、神经元特异性烯醇化酶(NSE)、降钙素原(PCT)、S100蛋白(S100)、高敏肌钙蛋白T检测(TNT-HS)、总血胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、腺苷脱氨酶(ADA)、前白蛋白(PA)、总蛋白(TP)、白蛋白(ALB)、球蛋白(GLO)、乳酸脱氢酶(LDH)、α-羟丁酸(HBDH)、肌酸激酶(CK)及肌酸激酶同工酶(CK-MB),采用Fisher逐步判别分析法对证型与检验指标的相关性进行分析。结果①与轻症组相比,重症手足口病患儿WBC、CD19+、NSE、DBIL和ALB水平较高(P<0.05),而MONO%、CD3+细胞和CD3+CD4+细胞、LDH及HBDH水平较低(P<0.05);②对重症手足口病判别能力较强的7个指标依次为CD19+、NSE、NEUT%、MONO%、DBIL、LDH、ALB,其对判别函数的贡献达100.0%;③重症手足口病的判别方程为:Y1=-190.462-0.102×NEUT%+2.926×MONO%+1.212×NSE+0.622×CD19++8.845×DBIL+6.181×ALB+0.104×LDH。结论①重症手足口病患儿的免疫功能、神经功能及肝脏、心脏功能等均有所改变;②CD19+可能对手足口病重症的诊断具有一定的敏感性;③临床上有可能运用判别方程进行手足口病重症进展的初步判断。
Objective To explore laboratory indexes for diagnosis of severe hand-foot-mouth (HFMD) so as to understand the essence of severe HFMD from the perspective of laboratory medicine.Methods We selected 50 severe HFMD patients as the case group and another 50 mild HFMD patients of the same period as the control group.Their whole blood samples were collected on empty stomach the next morning after their hospitalization.The following serum items were detected:white blood cells (WBC),red blood cells (RBC),platelets (PLT),neutrophils ratio (NEUT%),lymphocyte percentage (LYMPH%),monocyte ratio (MONO%),C-reactive protein (CRP),T cells (CD3+),Ts cells (CD3+CD8+),Th cells (CD3+CD4+),Th/Ts (CD4/CD8),NK cells (CD16+CD56+),B cells (CD19+),immunoglobulin M (IgM),immunoglobulin A (IgA),immunoglobulin G (IgG),complement C3 (C3),complement C4 (C4),erythrocyte sedimentation rate (ESR),neuron-specific enolase (NSE),calcitonin original (PCT),S100 protein (S100),high-sensitivity troponin T test (TNT-HS),total serum bilirubin (TBIL),direct bilirubin (DBIL),indirect bilirubin (IBIL),alanine aminotransferase (ALT),aspartate aminotransferase (AST),adenosine deaminase (ADA),prealbumin (PA),total protein (TP),albumin (ALB),globulin (GLO),lactate dehydrogenase (LDH),α-hydroxybutyric acid (HBDH),creatine kinase (CK) and creatine kinase (CK-MB).The correlation between symptom types and laboratory indexes were analyzed by Fisher gradual discriminant analysis.Results ① Serum levels of WBC,CD19+,NSE,DBIL and ALB were higher in severe HFMD group than in mild group (P<0.05),while MONO%,CD3+,CD3+ CD4+,LDH and HBDH were lower than those in the control group (P< 0.05).② The capacity of these indexes for diagnosing severe HFMD was ranked from high to low as CD19+,NSE,NEUT%,MONO%,DBIL,LDH and ALB,and the contribution rate of the above seven for the discriminant function was 100.0%.③ Discriminant analysis equation of severe HFMD was Y1 =-190.462-0.102× NEUT% +2.926 × MONO% +1.212 × NSE+0.622 × CD19+ +8.845 × DBIL+6.181 ×ALB+0.104 × LDH.Conclusion ① There are changes in immune function,nerve function,cardiac function,and the liver in severe HFMD children.② CD19+ may be a marker of high sensitivity for diagnosis of severe HFMD.③ It is possible for clinicians to use discriminant equation to judge the development of severe HFMD.
出处
《西安交通大学学报(医学版)》
CAS
CSCD
北大核心
2014年第4期504-508,共5页
Journal of Xi’an Jiaotong University(Medical Sciences)
基金
国家自然科学基金资助项目(No.81172740)~~
关键词
重症手足口病
实验室指标
免疫功能
心功
肝功
淋巴细胞
severe hand-foot-mouth disease
laboratory index
immune function
cardiac index
liver function
lymphocyte index