手足口病并发脑炎患儿血清乳酸含量变化及其与神经损伤、心肌酶谱及炎症因子的相关性

The correlation between the serum lactic acid level and the extent of nerve injury,myocardial enzymes and inflammatory factors in children with hand foot mouth disease combined with encephalitis

目的:探讨手足口病并发脑炎患儿血清乳酸含量的变化,并分析其与神经损伤、心肌酶谱及炎症因子的相关性。方法:选取2014年7月至2016年12月在湖北省孝感市中心医院住院治疗的手足口病并发脑炎患儿37例作为脑炎组,单纯手足口病患儿58例作为单纯手足口病组,另选取同期在本院进行体检的健康小儿50例作为正常对照组。采用酶比色法测定血清乳酸含量,酶联免疫吸附法测定血清神经损伤指标[神经特异性烯醇化酶(NSE)、S-100B蛋白、髓鞘碱性蛋白(MBP)]和炎症因子[白介素-6(IL-6)、白介素-18(IL-18)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]的含量,放射免疫法测定血清心肌酶谱指标[乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)、α-羟丁酸脱氢酶(α-HBDH)、天冬氨酸氨基转移酶(AST)]含量。采用Pearson相关分析法分析患儿血清乳酸含量与其神经损伤指标、心肌酶和炎症因子含量的相关关系。结果:脑炎组和单纯手足口病组血清乳酸、LDH、CK-MB、α-HBDH、AST、IL-6、IL-18、PCT、TNF-α、CRP含量均明显高于正常对照组,且脑炎组高于单纯手足口病组(均P<0.05)。脑炎组血清NSE、S-100B蛋白、MBP的含量显著高于单纯手足口病组和正常对照组(P<0.05)。脑炎组患儿血清乳酸含量与神经损伤指标、心肌酶谱、炎症因子含量均呈正相关关系(均P<0.05)。结论:手足口病并发脑炎患儿血清乳酸含量增高,且其含量变化与患儿神经损伤、心肌酶谱及炎症反应水平有关。

Objective： To investigate the association between the serum lactic acid level and the extent of nerve injury,myocardial enzymes and inflammatory factors in children with hand-foot-mouth disease （HFMD） combined with encephalitis.Methods： A total of 37 children with HFMD and encephalitis （encephalitis group） and 58 children with HFMD （HFMD group） in our hospital from July 2014 to December 2016 were selected.Fifty healthy children were defined as a control group.The levels of lactic acid,neuro-specific enolase （NSE）,S-100B protein,myelin basic protein （MBP）,interleukin-6 （IL-6）,interleukin-18 （IL-18）,procalcitonin （PCT）,tumor necrosis factor-α （TNF-α）,C-reactive protein （CRP）,lactate dehydrogenase （LDH）,creatine kinase MB isoenzyme （CK-MB）,α-hydroxybutyrate dehydrogenase （α-HBDH） and aspartate transaminase （AST） in serum were detected.The correlations among serum lactic acid level,the severity of nerve injury,myocardial enzymes and inflammatory factors in encephalitis group were analyzed.Results： Serum lactic acid,LDH,CK-MB,α-HBDH,AST,IL-6,IL-18,PCT,TNF-α and CRP levels in encephalitis group and HFMD group were higher than those in the control group,and these indexes were higher in encephalitis group （ P 〈0.05）.The levels of NSE,S-100B and MBP in encephalitis group were significantly higher than those in HFMD group and control group （ P 〈0.05）,but no significant difference was found between HFMD group and control group （ P 〉0.05）.Pearson correlation analysis revealed that the serum lactic acid level was positively correlated with the nerve injury indexes,myocardial enzymes and inflammatory factors contents in encephalitis group （ P 〈0.05）.Conclusion： Serum lactic acid level was elevated in children with HFMD combined with encephalitis,and it was associated with the severity of nerve injury,myocardial enzymes levels and inflammatory reactions.