EV71感染手足口病患儿高迁移率族蛋白-1水平变化的临床意义

Clinical significance of change in the high mobility group box-1 protein level in children with hand-foot-mouth diseases induced by EV71

目的探讨EV71感染手足口病患儿高迁移率族蛋白-1(HMGB1)水平变化和临床意义,为手足口病病情判断及预后评估提供依据。方法选择于武汉市医疗救治中心2015年4月-2016年4月住院治疗的手足口病患儿60例为研究对象,参照手足口病诊断标准将患儿分为轻症组34例和重症组26例,入组患儿手足口病毒学检测均为单纯EV71阳性,选择同期20名健康体检儿童为对照组。采用Real time-PCR检测各组外周血单核细胞HMGB1mRNA表达水平,同时采用ELISA方法检测各组血浆中HMGB1和肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)含量,分析各组间表达水平的差异及HMGB1和TNF-α、IL-6之间的相关性。结果治疗前,重症组外周血单核细胞中HMGB1mRNA表达水平、血浆HMGB1含量均高于轻症组(P<0.05),轻症组高于对照组(P<0.05);治疗后,轻症组与重症组外周血单核细胞中HMGB1 mRNA表达水平分别为(1.03±0.29)、(2.00±0.46),血浆HMGB1含量分别为(16.81±10.88)pg/ml、(29.85±6.17)pg/ml,均较治疗前下降(P<0.05);重症组TNF-α及IL-6均高于轻症组(P<0.05),轻症组TNF-α及IL-6均高于对照组(P<0.05);血浆中HMGB1含量与TNF-α和IL-6含量均呈正相关(P<0.05)。结论 HMGB1参与了手足口病的发生发展过程,HMGB1水平与手足口病的病情严重程度及转归密切相关。

OBJECTIVE To investigate the change in expression level and clinical significance of high mobility group box-1 protein（HMGB1）in children with hand-foot-mouth disease（HFMD）,so as to provide basis for the diagnosis and prognosis of HFMD.METHODS 60 children with hand-foot-mouth disease who were hospitalized Wuhan Medical treatment Center during April 2015-April 2016 were selected as the research sujects,and were divided into mild case group（34 cases）and severe case group（26 cases）according to the diagnostic criteria of HFMD.The virology detection of all cases showed EV71 postive results.Meanwhile,20 healthy children were chosen as the control group.The expression levels of HMGB1 mRNA in peripheral blood mononuclear cells of all groups were detected by RT-PCR.And the levels of HMGB1,TNF-αand IL-6 in plasma were measured by ELISA.The difference in expression levels among groups and the correlation between HMGB1,TNF-αand IL-6 were analyzed.RESULTS Before treatment,the level of HMGB1 mRNA in peripheral blood mononuclear cells and the HMGB1 content in plasma of the severe case group were both significantly higher than those in the mild case group（P〈0.05）,and those of the mild case group were significantly higher than those of the control group（P〈0.05）.After treatment,the HMGB1 mRNA in in peripheral blood mononuclear cells of the mild case group and the severe case group were（1.03±0.29）and（2.00±0.46）,and the plasma HMGB1 content was（16.81± 10.88）and（29.85±6.17）,respectively,which were all significantly lower than those before the treatment（P〈0.05）.Both the TNF-αand IL-6 levels in the severe case group were significantly higher than the mild case Ggroup（P〈0.05）,and the TNF-αand IL-6 levels of the mild case group were significantly higher than those in the control group（P〈0.05）.The content of HMGB1 in plasma was positively correlated with TNF-αand IL-6 levels.CONCLUSION HMGB1 was involved in the development of HFMD and the level of HMGB1 was closely related to the severity and transition of HFMD.