G6PD缺陷与肠道病毒71型手足口病的关系

Relationship between G6PD deficiency and hand-foot-mouth disease induced by enterovirus 71

目的探讨葡萄糖-6-磷酸脱氢酶(glucose-6-phosphate dehydrogenase,G6PD)缺陷对肠道病毒71型(Enterovirus 71,EV71)感染所致手足口病的影响及可能机制。方法选取确诊为EV71感染手足口病的男性患儿220例,根据病情分为普通组(145例)和重症组(75例);将同期体检的132例健康男性儿童设为对照组。用全自动生化仪进行血液中G6PD、还原型谷胱甘肽(GSH)及丙二醛(MDA)水平的测定。结果重症组G6PD缺陷比例明显高于对照组(P<0.0125)。重症组中G6PD缺陷患儿的总热程、精神异常时间、肢体抖动持续时间及住院时间均较G6PD正常者长(P<0.05)。急性期及恢复期普通组与重症组患儿血中GSH、G6PD水平均低于对照组(P<0.05),MDA水平均高于对照组(P<0.05)。普通组及重症组G6PD缺陷患儿急性期血GSH水平均低于G6PD活性正常患儿,MDA水平均高于G6PD活性正常患儿(P<0.01)。急性期及恢复期患儿GSH水平与G6PD活性均呈正相关(分别r=0.61、0.58,均P<0.01);急性期患儿MDA水平与G6PD活性呈负相关(r=-0.29,P<0.01)。结论 G6PD缺陷可能是EV71型手足口病的易感因素,伴G6PD缺乏的患儿病情可能更重,其机制可能与氧化应激有关。

Objective To study the influence of glucose-6-phosphate dehydrogenase （G6PD） deficiency on hand-foot-mouth disease （HFMD） induced by enterovirus 71 （EV71）, and possible mechanisms. Methods A total of 220 boys with HFMD induced by EV71 were classified into two groups based on disease severity： mild/moderate （n=145） and severe HFMD groups （n=75）, and 132 healthy boys were selected as the control group. The activity of G6PD and levels of reduced glutathione （GSH） and malonaldehyde （MDA） in blood were measured using the automatic biochemical analyzer. Results The percentage of G6PD deficiency cases in the severe HFMD group was significantly higher than in the control group （P〈0.0125）. In the severe HFMD group, the durations of fever, mental abnormality, limb trembling and hospital stay were significantly longer in children with G6PD deficiency than in those with normal G6PD activity （P〈0.05）. In the acute and recovery stages, patients in the mild/moderate and severe HFMD groups had significantly lower GSH levels and G6PD activity and significantly higher MDA levels compared with those in the control group （P〈0.05）. In the acute stage, children in the mild/moderate and severe HFMD groups with G6PD deficiency had significantly lower GSH levels and significantly higher MDA levels compared with those with normal G6PD activity （P〈0.01）. In the acute and recovery stages, GSH level in children with HFMD was positively correlated with G6PD activity （r=0.61, P〈0.01; r=0.58, P〈0.01）, and in the acute stage, MDA level was negatively correlated with G6PD activity （r=-0.29, P〈0.01）. Conclusions G6PD deficiency is probably a predisposing factor for HFMD induced by EV71 and may aggravate the patient＇s condition. Its mechanism might be related to oxidative stress.