危重型手足口病患儿水通道蛋白4的表达及其临床意义

Expressions and significance of aquaporin - 4 in children with severe hand - foot - mouth disease

目的探讨危重型手足口病（HFMD）患儿脑脊液及血清中水通道蛋白4（aquaporin－4，AQP－4）的表达水平及其意义。方法选取2017年2月至11月徐州市儿童医院收治的25例危重型HFMD患儿（临床分期3期）为研究对象（危重型组），选择同期感染科收治的经脑脊液等检查排除中枢神经系统感染的25例普通型HFMD（普通型组）及25例重症HFMD（临床分期2期，重症组）患儿作为对照。测定3组患儿脑脊液及血清AQP－4表达的水平，并同时测定患儿血清白细胞介素－6（IL－6）、去甲肾上腺素（NE）及神经元特异性烯醇化酶（NSE）水平，分析其与AQP－4水平变化的相关性。结果治疗前危重型组血清AQP－4水平为（54.42±19.86） μg/L，显著高于重症组[（22.04±8.14） μg/L]及普通型组[（8.02±1.59） μg/L]（F＝36.684，P〈0.01），危重型组及重症组患儿治疗后复查血清AQP－4水平较治疗前显著降低（P〈0.05）。治疗前危重型组及重症组脑脊液AQP－4水平分别为（9.81±2.27） μg/L、（8.58±1.92） μg/L，显著高于普通型组[（6.56±1.79） μg/L]（F＝6.713, P〈0.05）。治疗后危重型组脑脊液AQP－4水平为（8.41±1.63） μg/L ，重症组脑脊液AQP－4水平为（7.14±1.69） μg/ L，均较治疗前显著降低（t＝6.340、5.073，均P〈0.01）。3组患儿血清IL－6、NE、NSE水平差异有统计学意义（P〈0.01），与血清AQP－4水平呈正相关（r＝0.734、0.810、0.729，均P〈0.01），且与脑脊液AQP－4水平呈正相关（r＝0.299、0.431、0.363，均P〈0.05）。结论AQP－4参与了危重型HFMD的病理过程，血清AQP－4可作为临床判断HFMD患儿病情严重程度及预后的指标之一。

Objective To explore the levels of water channel protein 4 （aquaporin-4, AQP-4） in the serum and the cerebrospinal fluid of patients with severe hand-foot-mouth disease （HFMD） and its clinical significance.Methods Children with the critical HFMD （clinical stage 3） admitted to Xuzhou Children′s Hospital from February 2017 to November 2017 were recruited（critical group）. In the same period, another 25 cases of common HFMD （central nervous system infection excluded in cerebrospinal fluid examination, common group）, the other 25 cases of severe HFMD （clinical stage 2, severe group） were taken as the controls.The levels of AQP-4 in the serum and and cerebrospinal fluid were measured in all children and the levels of AQP-4 in cerebrospinal fluid were checked again in the critical and severe cases after treatment.The levels of interleukin-6（IL-6）, norepinephrine（NE） and neuron-specific enolase（NSE） in the serum were examined simultaneously and the correlation between them was analyzed.Results Before treatment, the levels of AQP-4 in the serum of critical group were（54.42±19.86） μg/L, which were significantly higher than common group[（8.02±1.59） μg/L] and severe group[（22.04±8.14） μg/L] （F=36.684, P〈0.01）. Compared with before treatment, the levels of AQP-4 in the serum of critical and severe group were significantly lower after treatment （P〈0.05）. Before treatment, the levels of AQP-4 in the cerebrospinal fluid of critical and severe cases were respectively （9.81±2.27） μg/L and （8.58±1.92） μg/L, which were significantly higher than common group（6.56±1.79） μg/L（F=6.713, P〈0.05）. After treatment, the levels of AQP-4 in the cerebrospinal fluid of critical and severe cases were （8.41±1.63） μg/L and （7.14±1.69） μg/ L separately, which were significantly lower than before treatment （t=6.340, 5.073, all P〈0.01）. The levels of IL-6, NE and NSE in serum were significantly different among the three groups（P〈0.01）. The above indicators were positively correlated with the levels of AQP-4 in the serum（r=0.734, 0.810, 0.729, all P〈0.01）and were also positively correlated with AQP-4 in the cerebrospinal fluid（r=0.299, 0.431, 0.363, all P〈0.05）.Conclusion AQP-4 may participate in pathophysiological processes of HFMD.The levels of AQP-4 in serum can be used as an indicator for judging the severity and monitor prognosis of HFMD.