手足口病患儿血浆循环DNA水平的变化

The level of peripheral circular DNA in patients with hand foot and mouth disease

目的 探讨循环DNA能否作为手足口病（hand foot and mouth disease,HFMD）重要脏器早期损害的实验室指标.方法 采集78例HFMD患儿发病3日内和恢复期静脉血,采用双重荧光定量PCR技术检测血浆DNA水平,同时检测血糖、超敏C反应蛋白（high-sensitive CRP,hs-CRP）及血白细胞.同期采集30例健康体检儿童静脉血作为对照组.结果 健康儿童血浆循环DNA水平为（6.57±4.67） ng/ml,普通病例和重症病例HFMD患儿治疗前循环DNA水平分别为（11.51±7.75）和（ 20.59±10.67） ng/ml.普通病例和重症病例循环DNA水平均显著高于健康儿童（P =0.021;0.000）,而且重症病例显著高于普通病例（P=0.011）.重症HFMD患儿治疗后循环DNA水平显著降低（P=0.033）,而普通型患儿治疗后循环DNA水平无显著变化.重症HFMD患儿血糖和hs-CRP 水平在治疗前均显著高于普通病例（P=0.045,0.011）,普通病例血白细胞、血糖和hs-CRP水平在治疗前后均无显著变化.HFMD患儿外周循环DNA水平与hs-CRP呈显著正相关（P =0.021）,但与血糖、白细胞无显著相关性.结论 血浆循环DNA不但可以作为重症HFMD病例早期识别的指标,也可作为重症病例疗效的监测指标.

Objective To determine the circular DNA level of patients with hand foot and mouth disease （HFMD） and evaluate its potential clinical value.Methods Venous blood in 30 healthy children and 78 patients with HFMD within 3 days of onset of illness and convalescent period was collected.The level of plasma circular DNA was detected by duplex real-time polymerase chain reaction assay.Blood sugar,high-sensitive CRP（hs-CRP） and leucocyte were also detected.Results The level of circular DNA in control group was （ 6.57 ± 4.67 ） ng/ml.The level of circular DNA in ordinary and severe HFMD patients was （ 11.51 ±7.75） ng/ml and （20.59 ± 10.67 ） ng/ml before treatment,respectively.The levels of circular DNA in ordinary and severe HFMD patients were significantly higher than that in control group（P =0.021 ;0.000） ; the level of circular DNA in severe HFMD patients was significantly higher than that in ordinary HFMD patients（ P =0.011 ）.The level of circular DNA in severe HFMD patients after treatment were significantly lower than that before treatment（ P =0.033 ）.The level of circular DNA before treatment and after treatment in ordinary HFMD patients had no significant difference.The levels of blood sugar and hs-CRP in severe HFMD patients were higher than those in ordinary before treatment （P =0.045; 0.011 ）.The levels of blood sugar and hs-CRP before treatment and after treatment in ordinary HFMD patients had no significant change.There was significantly positive correlation between the level of circular DNA and that of hs-CRP in HFMD patient（P =0.021 ）,but there was no correlation between the level of circular DNA and that of blood sugar and leucocyte.Conclusions The level of circular DNA not only become an early identification marker of severe H FM D patients,but also become monitoring marker of effect of treatment.