重症手足口病患儿血清去甲肾上腺素水平变化及其他相关因素分析

Change of Serum Norepinephrine in Children with Severe Hand-Foot-Mouth Disease and Analysis of Other Related Factors

目的探讨去甲肾上腺素(NE)在重症手足口病(HFMD)病理生理过程中的作用机制,寻找重症HFMD患儿病情进展的早期预警指标。方法以304例重症HFMD患儿及19例因HFMD死亡患儿(共323例)为研究对象,所有病例分为3组:重症组、危重症组及死亡组,所有患儿入院后在其病程急性期测定血清NE水平,同时行血常规、血糖、心肌酶及病原学等常规检查。应用SPSS13.0软件对各组数据进行分析。结果 HFMD≤3岁患儿288例,占89.2%。318例(98.5%)患儿有发热症状,322例(99.7%)患儿有不同部位的皮疹,1例无皮疹者为死亡病例。3组血清NE水平均明显高于正常值,且随病情进展NE有增高趋势;随病情进展呼吸、心率逐渐增快,血压逐渐增高,3组比较差异均有统计学意义(Pa<0.01);血糖、白细胞、脑脊液蛋白、CK-MB随病情进展亦有增高趋势,死亡组明显高于其他2组(P<0.01,0.05);107例患儿实验室病原学检查阳性,其中EV71感染患儿75例(70.1%)。结论血清NE水平增高、EV71病原学阳性、脑脊液蛋白及血中CK-MB增高,均是重症HFMD病例的早期识别指标。

Objective To explore the pathophysiological mechanism of norepinephrine（NE） in order to investigate the predictors for severe hand -foot -mouth disease （HFMD）. Methods Three hundred and four cases of children who were diagnosed as HFMD and 19 cases of children who died of HFMD （all 323 cases） were selected in this study. The subjects were divided into 3 groups：severe HFMD group, critical HFMD group and death group. Venous blood samples were collected after the patients were admitted to the hospital. NE level was detected. All the data were analyzed by SPSS 13.0. Results The children less than 3 years old （ including 3 years） were 288 cases and they accounted for 89.2% of the subjects,318 cases （98.5%） had fever symptom,322（99.7% ） cases had rash at different sites, and 1 case in death group had no rash. NE levels in 3 groups were higher than the normal value, and the NE level gradually increased when the illness was growing worse; breathing, heart rate and blood pressure gradually increased when the illness got worse, and the differences among the 3 groups were statistically significant（Pa 〈 0.01 ） ; white blood cells, blood glucose, MB isoenzyme of creatine kinase and ccrebrospinal fluid protein gradually increased when patients＇ conditions worsened, and the NE level in death group was higher than that in other two groups （ P 〈 0.01,0.05 ） ; 107 cases had positive etiology laboratory results, including 75 cases with enterovirus 71 （ 70.1% ）. Conclusions The increase in the NE level, MB isoenzyme of creatine kinase and cerebrospinal fluid protein and positive of enterovirus 71 are the predictors of severe HFMD.