不同临床分期EV71感染重症患儿血浆去甲肾上腺素、肾上腺素水平的变化及临床意义

Alteration of Plasma Norepinephrine and Epinephrine in Different Clinical Stages of Children with Severe HFMD infected by EV71 and Its Clinical Significance

目的：探讨肠道病毒71型（EV71）感染重症手足口病患儿血浆去甲肾上腺素（NE）、肾上腺素（E）水平在不同临床时期的变化及其临床意义。方法：按临床分期将我院在2011年6月至2013年5月期间确诊为EV71感染的重症手足口病患儿分为4组：2期30例（研究1组）、3期30例（研究2组）、4期16例（研究3组，不含死亡病例），死亡组6例（研究4组），同时设手足口病普通对照组和健康对照组各30例。研究1、2、3组分别于急性期（入院当天或次日）及恢复期（病程第10∽14天），研究4组于急性期，收集外周血标本测定血浆肾上腺素、去甲肾上腺素的水平。结果：在急性期，研究1组血浆NE、E水平与普通对照组之间的差别无统计学意义（ p〉0.05），研究2、3、4组NE、E血浆水平均高于普通对照组（ p〈0.05），且随着病情的加重呈增高趋势。4个研究组急性期NE、E血浆水平均高于健康对照组（ p〈0.05）。研究1组的NE、E水平在急性期、恢复期比较无统计学差异（ p〉0.05）；研究2、3组恢复期的NE、E水平较急性期降低（ p〈0.05）。结论：EV71感染重症手足口病患儿血浆NE、E水平明显上升，交感神经功能亢进是导致神经源性肺水肿的重要发病机制之一。病程中监测NE、E血浆水平的变化可作为判断病情变化及疗效的指标，可能早期预测NpE的发生。

Objective：To explore the alteration of plasma norepinephrine（ NE）and epinephrine（ E）in different clinical stages of children with severe hand-foot-mouth disease（HFMD）infected by entero virus 71（ EV71）and its clinical sig-nificance. Methods：According to the clinical stages,patients with severe HFMD infected by EV71 who were treated in our hospital from June,2011 to May,2013 were divided into four groups：30 cases for phase 2（Study Group 1）,30 cases for phase 3（Study Group 2）,16 cases for phase 4（Study Group 3,not containing death cases）,6 cases for death group（Study Group 4）. The ordinary control group included 30 cases of mild hand-foot-mouth disease. Healthy control group included 30 healthy children during the same period in our hospital. Their plasma were collected respectively during acute phase and convalescence phase（Study Group 1,2 and 3）,while the plasma of Study Group 4 were collected during acute phase. Then NE and E in plasma were measured respectively. Results：For NE and E levels in plasma of acute phase,there was no statistically significant difference between study group 1 and ordinary control group. Levels of the other study groups were higher than ordinary control group,and rising as the aggravation of the disease. NE and E levels of the four study groups were higher than healthy control group. For study group1,there were no statistically significant differences among levels of acute phase and convalescence. For study group 2 and 3,the levels of plasma NE and E during convalescence was lower than those during acute phase. Conclusion：Levels of NE and E in plasma of children with severe HFMD infec-ted by EV71 rose visibly,increased sympathetic tone is important pathogenesis of neurogenic pulmonary edema（ NpE. Surveying the alteration of plasma NE and E in different clinical periods may act as a benchmark in estimating patient′s condition and curative effect,and calculating NpE.