EV71相关手足口病并发肺水肿血清IgM水平的变化

THE CHANGES OF IgM LEVELS IN CHILDREN WITH ENTEROVIRUS-71-RELATED HAND,FOOT AND MOUTH DISEASE COMPLICATED BY PULMONARY EDEMA

目的探讨EV71相关手足口病并发肺水肿病儿血清IgM水平的变化及其意义。方法将90例EV71感染病儿分为手足口病并发肺水肿组(并发症组)38例,手足口病无并发症组(无并发症组)52例,分别检测入院时、治疗2～3 d及治疗好转时血清IgM水平,以及入院时血清IgGI、gA及补体C3、C4含量,并以健康查体儿童28例作为对照组。结果入院时手足口病组血清IgM水平高于对照组,并发症组高于无并发症组,差异有显著性(F=14.967,q=7.917、5.030,P<0.05);各组之间IgG与IgA差异无显著性(P>0.05);手足口病病儿血清C3及C4含量均明显低于对照组(F=46.079、62.794,q=3.735～14.233,P<0.05)。不同时间手足口病无并发症组病儿血清IgM水平差异无显著性(F=0.068,P>0.05);并发症组病儿治疗2～3 d后IgM水平较入院时明显升高,治疗好转时明显回落,差异有显著性(F=9.189,q=2.802、2.709,P<0.05)。结论血清IgM水平持续升高可能是手足口病并发肺水肿重要的血清学指标之一,其血清水平可以用于判断病情的变化。

Objective To study the changes of serum IgM levels in children with enterovirus-71-related hand,foot and mouth disease complicated by pulmonary edema. Methods Children infected by enterovirus-71 were divided into two groups： 38 with pulmonary edema and 52 patients without the complication.IgM was detected on admission,after 2-3 days of treatment,and when improved;serum IgG,IgA,and complements（C3,C4） were detected on admission,the results were compared with 28 healthy children. Results On admission,serum IgM levels in the patients were higher than that in the control,that in complication group were higher than that without complication,the differences were significant among them（F=14.967;q=7.917,5.030;P0.05）.The differences of IgG and IgA levels among the three groups were not significant（P0.05）.The serum levels of C3 and C4 in sick children were significantly lower than that in the control（F=46.079,62.794;q=3.735-14.233;P0.05）.Serum IgM levels detected at different time in patients without complication were not significantly different（F=0.068,P0.05）,for those with complication,the IgM level was markedly elevated after 2-3-day treatment compared with that on admission,and then declined as the condition improved after treatment,the difference being significant（F=9.189;q=2.802,2.709;P0.05）. Conclusion The persistent elevation of serum IgM level is like to be one of the important serological indexes in hand-foot-mouth disease complicated by edema of lung,this marker can be used to predict the patient＇s condition.