手足口病患儿血清心肌酶、乳酸水平与病毒载量的检测及意义

Clinical significance of serum myocardial enzyme,lactic acid and enterovirus load in children with hand,foot and mouth disease

目的探讨手足口病(hand,foot and mouth,HFMD)患儿血清心肌酶、乳酸水平与病毒载量的临床意义。方法将病例组482例患儿分为EV71轻度组、EV71重症组、Cox A16轻度组和Cox A16重症组;对照组为同期体检正常的健康儿童212例。采用酶法检测血清心肌酶水平;采用免疫比浊法检测心肌肌钙蛋白I(cardiac troponin I,c Tn I)水平;采用酶比色法检测血清乳酸(lactic acid,LAC)水平;采用反转录酶-聚合酶链反应(reverse transcription-polymerasechain reaction,RT-PCR)技术检测肠道病毒71型(Enterovirus 71,EV71)和柯萨奇A组16型(Coxsackie A16,Cox A16)病毒核酸。结果 HFMD患儿心肌酶各指标和乳酸水平均高于对照组(P<0.05)。心肌酶各指标水平在病例组中两两亚组间比较,差异均无统计学意义(P>0.05);EV71重症组、Cox A16重症组血清乳酸水平均高于EV71轻度组和Cox A16轻度组(P<0.05)。EV71轻度组、EV71重症组、Cox A16轻度组和Cox A16重症组HFMD患儿病毒载量比较,差异有统计学意义(P<0.01);其中EV71轻度组、EV71重症组HFMD患儿病毒载量低于Cox A16轻度组和Cox A16重症组(P<0.05)。患儿心肌酶水平与咽拭子病毒载量、病情轻重无相关性(P>0.05),与血清乳酸水平呈正相关(P<0.05)。结论手足口病患儿机体免疫反应可能造成心肌细胞不同程度的损伤。心肌酶水平与病毒种类、病毒载量无关,其水平高低不能单独作为病情的评判标准;心肌酶水平与血清乳酸的联合检测可能有一定的价值。

Objective To detect serum myocardial enzyme,lactic acid（LAC）and enterovirus load of children with hand,foot and mouth disease（HFMD）and discuss their clinical significance. Methods A total of 482 children with HFMD weredivided into EV71 severe group,EV71 mild group,Cox A16 mild group,and Cox A16 severe group. And, at the same period,212 healthy children consisted of a control group. The levels of serum AST,LDH,CK and CKMB were detected by enzymaticmethods; the levels of c Tn I were detected by the immune turbidimetric assay; the levels of serum LAC were detected byenzyme-colorimetry; the viral loads of EV71 and Cox A16 RNA were detected by RT-PCR. Results The levels of myocardialenzyme and LAC in the disease groups were higher than those in the control group（P〈0.05）. The levels of myocardial enzymewere compared between each two disease groups,and there were no statistically differences（P〉0.05）,respectively. The levelsof serum LAC in the EV71 severe group and Cox A16 severe group were higher than those in the EV71 mild group and Cox A16 mild group（P〈0.05）. The levels of viral load were compared between each two disease groups,and there were statisticallysignificant differences（P〈0.01）. The levels of viral load in the mild EV71 group and EV71 severe group were lower than thosein the Cox A16 mild group and Cox A16 severe group（P〈0.05）,respectively. There were no significant correlation between thelevels of myocardial enzyme and swab enterovirus load,and the state of HFMD（P〉0.05）. However,there was a positivecorrelation between the levels of myocardial enzyme and serum LAC（P〈0.05）. Conclusion The immune response ofchildren with HFMD may cause different degrees of myocardial cell damage. There are no significant correlation between thelevel of myocardial enzyme and the kinds of enterovirus,and viral load. The level of myocardial enzyme might not serve as theseparately criteria of the state of HFMD. The joint detection of myocardial enzyme and serum LAC may have certain value.