危重症EV71感染患儿血浆儿茶酚胺水平测定及临床意义

Detection of catecholamine in critically ill children with EV71 Infection at different clinical stages and its clinical significance

目的比较危重症EV71感染患儿各临床分期血多巴胺（DA）、肾上腺素（E）、去甲肾上腺素（NE）的水平,观察各临床分期儿茶酚胺（CA）的变化并分析其临床意义。方法收集2012年5月~2014年5月深圳市龙岗中心医院收治的危重症EV71感染患儿10例,结合各患儿临床分期分为4组,手足口出疹期为1组;神经系统受累期为2组;心肺功能衰竭前期为3组;心肺功能衰竭期为4组。选取同期在深圳市龙岗中心医院门诊就诊20例EV71感染患儿为普通EV71感染组。以同期在深圳市龙岗中心医院儿童保健科体检儿童为对照组,共20例。采用酶联免疫吸附法测定血浆CA水平,同时记录患儿采血前的心率、呼吸频率;分析血浆CA水平与心率、呼吸频率相关性。结果与对照组比较,1~4组各临床分期血浆CA水平均有不同程度的升高（P〈0.05）,普通EV71感染者血浆CA水平无明显升高（P〉0.05）。3组、4组DA、E和NE水平较对照组升高明显（P〈0.01）,较1、2组显著升高（P〈0.01）;2组、3组、4组心率、呼吸较对照组明显升高（P〈0.01）;对照组、普通EV71感染者及1~4组CA水平与心率呈正相关。结论危重症EV71感染患儿手足口出疹期存在神经系统受累的可能。对EV71感染患儿进行CA检测,可以预警病情。

Objective To detect the plasma levels of dopamine（DA）, epinephrine（E）, norepinephrine（NE） in criticallyill children with emterovirus 71（EV71） infection at different clinical stages and observe the changes of catecholamine（CA）.Methods Ten critically ill children with EV71 infection in our hospital were selected from May 2012 to May 2014.According to various clinical stages, critically ill children with EV71 infection were divided into 4 groups,the cases with hand-foot-mouth disease rash were divided into group 1, those with nervous system involvement were divided into group 2, those withcardiopulmonary failure at prophase were divided into group 3, and the heart and lung cardiopulmonary failure cases weredivided into group 4. Twenty clinic patients with EV71 infection were selected as the normal EV71 infection group at the sametime. Twenty healthy children were selected as the control group at the same time. The plasma CA levels were measured byenzyme linked immunosorbent assay. The heart and respiratory rates were recorded before blood sampling. The correlation ofplasma CA level with heart and respiratory rate was analyzed. Results Compared with the control group, the plasma levels ofCA were increased in groups 1~ 4（P〈0.05）, but not increased in cases of normal EV71 infection group（P〉0.05）. The DA, E andNE levels in group 3 and group 4 were significantly higher than that of control group（P〈0.01）. Compared with groups 1 and 2,the levels of CA were increased in cases of groups 3 and 4（P〈0.01）. The heart and respiratory rates were significantly higher incases of groups 2, 3 and 4 than the control group（P〈0.01）.The CA levels in control group, normal EV71 infection group andgroup 1-4 were positively correlated with heart rate. Conclusion Nervous system may be involved in critically ill childrenwith EV71 infection at the hand- foot-mouth rash stage. The CA level might be one of the early severity indicator for detectionof EV71 infection.