手足口病患儿皮质醇、β-内啡肽和部分细胞因子监测的临床价值研究

Clinical values of cortisol,β-endorphin and some cytokines in children with HFMD

目的对肠道病毒71型(EV71)感染的手足口病患儿进行皮质醇(COR)、β-内啡肽(β-EP)和部分细胞因子的监测,探讨它们在疾病中的水平变化及对临床的指导价值。方法按照临床诊断和分型标准将手足口患儿分为普通型、重型和危重型3组,同时以健康儿童作为对照组。采集各病例组和对照组的静脉血,采用化学发光分析法检测COR、白细胞介素-13(IL-13)和干扰素-γ(IFN-γ),采用放射免疫法检测β-EP。各病例组患儿在治疗7d后再次采样,以同样的方法检测以上4项指标。结果与对照组比较,3组手足口病患儿的COR、β-EP、IL-13和IFN-γ水平均显著增高,差异有统计学意义(P<0.01);而3组手足口病患儿之间比较,4项指标的水平随着病情的加重而增高,差异有统计学意义(P<0.01)。经过7d治疗后,普通型手足口病患儿4项指标全部下降,几乎恢复到对照组的水平,与治疗前比较差异均有统计学意义(P<0.01);重型手足口病患儿的COR、β-EP、IL-13水平较治疗前大幅降低,但IFN-γ水平较治疗前增高,差异均有统计学意义(P<0.01);危重型手足口病患儿除了IFN-γ外,其他各项指标不降反升,差异有统计学意义(P<0.01)。结论血清COR、β-EP、IL-13和IFN-γ在手足口病的进程中变化明显,对病情判断和治疗有一定的参考价值。

Objective To explore the changes of cortisol （COR）,β-endorphin （β-EP）and some cytokines in children with hand, foot and mouth disease （HFMD）caused by EV71 infection and discuss their clinical value.Methods HFMD patients were divided into three groups,including common type group,severe type group and critical type group according to the clinical diagnosis and classification standards.Meanwhile,healthy children were enrolled as control group.Peripheral blood samples were collected and detected for concentrations of COR,interleukin-13 （IL-13）and interferon-γ（IFN-γ）by chemiluminescence assay,and concentration ofβ-EP by radioimmunoassay.At the same time,case groups were detected for all indexes 7 days after treatment.Results Com-pared with control group,levels of COR,β-EP,IL-13 and IFN-γwere significantly increased in the three case groups （P〈0.01）. Levels of the four indexes increased with the increasing of disease condition of HFMD （P〈0.01）.After 7 days of treatment,levels of the four indicators were decreased more significantly in common type group （P〈0.01）.Levels of COR,β-EP and IL-13 were de-creased apparently in severe type group,but IFN-γlevel was increased （P〈0.01）.In critical type group,except IFN-γ,levels of the other three indicators were increased after treatment （P〈0.01）.Conclusion Levels of COR,β-EP,IL-13 and IFN-γcould be changed obviously during the process of HFMD,which might be with reference value for the judgment of disease condition and treatment.