血清S100B蛋白和神经元特异性烯醇化酶预测手足口病严重程度的价值

Value of serum S100B protein and neuron-specific enolase levels in predicting the severity of hand,foot and mouth disease

目的探讨手足口病(HFMD)患儿血清S100B蛋白和神经元特异性烯醇化酶(NSE)水平检测对预测HFMD严重程度的价值。方法将90例HFMD患儿分为普通型、重型和危重型3组,每组30例;随机选取30例健康儿童作为对照组。ELISA法检测治疗前及治疗后7 d血清S100B蛋白和NSE水平。采用受试者操作特征曲线(ROC曲线)评价S100B蛋白和NSE对HFMD严重程度的预测效能。结果危重型HFMD患儿血清S100B蛋白和NSE水平均较其他3组明显升高(P<0.01);重型患儿血清S100B蛋白和NSE水平均较普通型和对照组明显升高(P<0.01)。与治疗前比较,危重型组和重型组治疗后血清S100B蛋白及NSE水平明显下降(P<0.05)。当血清S100B蛋白在0.445μg/L时其Youden值最大,为0.611,其对重症HFMD(包括重型和危重型HFMD)预测的灵敏度为61%,特异度为100%。血清NSE在5.905μg/L时其Youden值最大,为0.533,其对重症HFMD预测的灵敏度为80%,特异度为73%。两个指标并联检测的灵敏度为86%,特异度为73%,对预测重症HFMD的价值最高。结论血清S100B蛋白和NSE有助于判断HFMD病情严重程度及治疗效果;二者如能并联检测对重症HFMD的预测价值更高。

Objective To study the value of serum S100 B protein and neuron-specific enolase（NSE） levels in predicting the severity of hand, foot and mouth disease（HFMD）. Methods Ninety children with HFMD were classified into three groups： common type, severe type, and critical type（n=30 each）. Thirty healthy children were randomly selected as the control group. ELISA was used to measure serum levels of S100 B protein and NSE before and at 7 days after treatment. The receiver operating characteristic（ROC） curve was used to evaluate the prediction efficiency of S100 B protein and NSE for the severity of HFMD. Results The critical type group had significant increases in the serum levels of S100 B protein and NSE compared with the other three groups（P〈0.01）. The severe type group had significant increases in serum levels of S100 B protein and NSE compared with the common type and control groups（P〈0.01）. The critical type and severe type groups had significant reductions in serum levels of S100 B protein and NSE after treatment（P〈0.05）. Serum S100 B protein had the highest Youden value of 0.611 at the cut-off value of 0.445 μg/L, with a sensitivity of 61% and a specificity of 100%, in the prediction of serious HFMD（including severe type and critical type HFMD）. Serum NSE had the highest Youden value of 0.533 at the cut-off value of 5.905 μg/L, with a sensitivity of 80% and a specificity of 73%, in the prediction of serious HFMD. Combined measurements of these two parameters had a sensitivity of 86% and a specificity of 73% and had the highest predictive value for serious HFMD. Conclusions The serum levels of S100 B protein and NSE help to predict the severity and treatment outcomes of HFMD. Combined measurements of these two parameters has a higher predictive value for serious HFMD.